Provider Demographics
NPI:1205616919
Name:DOBSON, KATHERINE (LSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DOBSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:DOBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:947 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3051
Mailing Address - Country:US
Mailing Address - Phone:317-450-8415
Mailing Address - Fax:
Practice Address - Street 1:7043 COPPICE LN APT 7207
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-9042
Practice Address - Country:US
Practice Address - Phone:317-324-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011728A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker