Provider Demographics
NPI:1841580768
Name:LADD, KATHRYN MARIE (LISW, LMHP, RPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:LADD
Suffix:
Gender:F
Credentials:LISW, LMHP, RPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW, LMHP, RPT
Mailing Address - Street 1:508 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-6507
Mailing Address - Country:US
Mailing Address - Phone:712-352-2110
Mailing Address - Fax:712-352-1688
Practice Address - Street 1:508 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-6507
Practice Address - Country:US
Practice Address - Phone:712-352-2110
Practice Address - Fax:712-352-1688
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6744104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker