Provider Demographics
NPI:1942425186
Name:DENKOWSKI, KATHRYN MARY (EDD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARY
Last Name:DENKOWSKI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100784
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-0784
Mailing Address - Country:US
Mailing Address - Phone:817-336-7929
Mailing Address - Fax:
Practice Address - Street 1:1701 RIVER RUN
Practice Address - Street 2:SUITE #1105
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6579
Practice Address - Country:US
Practice Address - Phone:817-336-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22469103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BY68Medicare ID - Type Unspecified