Provider Demographics
NPI:1871017160
Name:WILDEROTTER, KATHRYN (LCSW-C, CTP-C)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:WILDEROTTER
Suffix:
Gender:F
Credentials:LCSW-C, CTP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17904 GEORGIA AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2277
Mailing Address - Country:US
Mailing Address - Phone:240-304-3327
Mailing Address - Fax:
Practice Address - Street 1:402 HUNGERFORD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4119
Practice Address - Country:US
Practice Address - Phone:301-294-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical