Provider Demographics
NPI:1457942674
Name:KINGERY, KATHERYN JANELLE
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:JANELLE
Last Name:KINGERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 2ND AVENUE WEST N # 100
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3910
Mailing Address - Country:US
Mailing Address - Phone:406-300-2984
Mailing Address - Fax:406-314-6186
Practice Address - Street 1:285 2ND AVENUE WEST N # 100
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3910
Practice Address - Country:US
Practice Address - Phone:406-300-2984
Practice Address - Fax:406-314-6186
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT48072101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)