Provider Demographics
NPI:1255736732
Name:WARNER, KATHRYN CARDUCK (PT)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:CARDUCK
Last Name:WARNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 COLUMBINE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4707
Mailing Address - Country:US
Mailing Address - Phone:719-360-0987
Mailing Address - Fax:
Practice Address - Street 1:1429 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4707
Practice Address - Country:US
Practice Address - Phone:719-360-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1449252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency