Provider Demographics
NPI:1952649535
Name:WOOLDRIDGE, KATHERINE MARIE (MED, PLPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1601
Mailing Address - Country:US
Mailing Address - Phone:660-621-4367
Mailing Address - Fax:
Practice Address - Street 1:413 E SPRING ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1573
Practice Address - Country:US
Practice Address - Phone:660-882-6400
Practice Address - Fax:660-882-7137
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013000302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional