Provider Demographics
NPI:1356366397
Name:JANSEN, KATHLEEN M (PSYD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:JANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SHINGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6340
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015819103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA367035OtherMHN TRICARE
PA815894000OtherMAGELLAN BEHAVIORAL HEALTH
PA095433Medicare ID - Type Unspecified
PA244409EZ3Medicare PIN
PA367035OtherMHN TRICARE