Provider Demographics
NPI:1023252277
Name:MARTIN, KATHLEEN ELAINE
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELAINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-2137
Mailing Address - Country:US
Mailing Address - Phone:785-628-2871
Mailing Address - Fax:785-628-0330
Practice Address - Street 1:211 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-2137
Practice Address - Country:US
Practice Address - Phone:785-877-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0006414101YP2500X
KS2746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional