Provider Demographics
NPI:1467277897
Name:PAULSON, KATHRYN GRACE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:PAULSON
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 1:706 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57469
Mailing Address - Country:US
Mailing Address - Phone:605-233-1504
Mailing Address - Fax:
Practice Address - Street 1:706 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1040
Practice Address - Country:US
Practice Address - Phone:605-233-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20876101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor