Provider Demographics
NPI:1790886653
Name:NORDAL, KATHERINE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:C
Last Name:NORDAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-2913
Mailing Address - Country:US
Mailing Address - Phone:601-634-0118
Mailing Address - Fax:
Practice Address - Street 1:1121 GROVE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2913
Practice Address - Country:US
Practice Address - Phone:601-634-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist