Provider Demographics
NPI:1457059925
Name:CLANG, KATHERINE LEIGH (QMHS,CCMA, CHW,CPT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LEIGH
Last Name:CLANG
Suffix:
Gender:F
Credentials:QMHS,CCMA, CHW,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLANSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45332-9749
Mailing Address - Country:US
Mailing Address - Phone:837-459-5392
Mailing Address - Fax:
Practice Address - Street 1:236 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLANSBURG
Practice Address - State:OH
Practice Address - Zip Code:45332-9749
Practice Address - Country:US
Practice Address - Phone:837-459-5392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCHW.001672172V00000X
OH3747P1801X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH960Medicaid
OHE251S00000XMedicaid
OH3747P1801XMedicaid