Provider Demographics
NPI:1962865493
Name:KATHRYN LADD, LLC
Entity Type:Organization
Organization Name:KATHRYN LADD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OWNER, CLINICAL SOCIAL WK
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:LLC, LISW, LMHP
Authorized Official - Phone:712-352-2110
Mailing Address - Street 1:508 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-6507
Mailing Address - Country:US
Mailing Address - Phone:712-352-2110
Mailing Address - Fax:712-352-1688
Practice Address - Street 1:508 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-6507
Practice Address - Country:US
Practice Address - Phone:712-352-2110
Practice Address - Fax:712-352-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty