Provider Demographics
NPI:1891036299
Name:WALDEN, KATHERINE JILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JILL
Last Name:WALDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:JILL
Other - Last Name:ENGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11312 SILVER WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9541
Mailing Address - Country:US
Mailing Address - Phone:415-302-2764
Mailing Address - Fax:
Practice Address - Street 1:11899 EDGEWOOD RD
Practice Address - Street 2:G
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3437
Practice Address - Country:US
Practice Address - Phone:415-302-2764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18936103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical