Provider Demographics
NPI:1295151496
Name:MALSOM, KATHERINE KAY (BCABA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KAY
Last Name:MALSOM
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4348
Mailing Address - Country:US
Mailing Address - Phone:605-262-2162
Mailing Address - Fax:605-262-0162
Practice Address - Street 1:405 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4348
Practice Address - Country:US
Practice Address - Phone:605-262-2162
Practice Address - Fax:605-262-0162
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0-11-4159103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst