Provider Demographics
NPI:1801001672
Name:EMERICK, KATHLEEN ANN (BSDT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:EMERICK
Suffix:
Gender:F
Credentials:BSDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-2348
Mailing Address - Country:US
Mailing Address - Phone:618-283-8798
Mailing Address - Fax:618-283-2155
Practice Address - Street 1:229 N 2ND ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-2348
Practice Address - Country:US
Practice Address - Phone:618-780-2725
Practice Address - Fax:618-283-2155
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist