Provider Demographics
NPI:1275830648
Name:HIESTAND, KATHERINE RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:RUTH
Last Name:HIESTAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 TUTWILER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-4538
Mailing Address - Country:US
Mailing Address - Phone:901-486-5745
Mailing Address - Fax:
Practice Address - Street 1:1722 TUTWILER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-4538
Practice Address - Country:US
Practice Address - Phone:901-486-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist