Provider Demographics
NPI:1851865703
Name:BROSSART, KATHERINE BERNADETTE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BERNADETTE
Last Name:BROSSART
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 1:33 WEST 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1298
Mailing Address - Country:US
Mailing Address - Phone:937-293-1945
Mailing Address - Fax:937-293-8150
Practice Address - Street 1:33 WEST 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1298
Practice Address - Country:US
Practice Address - Phone:937-293-1945
Practice Address - Fax:937-293-8150
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator