Provider Demographics
NPI:1821596305
Name:MAISCH, KATELYN DIANE
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:DIANE
Last Name:MAISCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0469
Mailing Address - Country:US
Mailing Address - Phone:509-232-8138
Mailing Address - Fax:509-232-8344
Practice Address - Street 1:501 N RIVERPOINT BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-232-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator