Provider Demographics
NPI:1669138061
Name:VAN DER RIET, CATHRYN (CPM, LM)
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:VAN DER RIET
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:VAN DER RIET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:7000 CONVICT HILL RD APT 1110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1706
Mailing Address - Country:US
Mailing Address - Phone:510-485-1795
Mailing Address - Fax:
Practice Address - Street 1:7000 CONVICT HILL RD APT 1110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1706
Practice Address - Country:US
Practice Address - Phone:510-485-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing