Provider Demographics
NPI:1851750160
Name:SMITH, KATHLEEN CHRISTENSEN (LAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CHRISTENSEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3985
Mailing Address - Country:US
Mailing Address - Phone:443-362-9355
Mailing Address - Fax:
Practice Address - Street 1:10 S HANSON ST STE 27
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3078
Practice Address - Country:US
Practice Address - Phone:443-362-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist