Provider Demographics
NPI:1720242134
Name:YALE, KATHLEEN KNOX (ED D)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KNOX
Last Name:YALE
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 LESTER RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7129
Mailing Address - Country:US
Mailing Address - Phone:850-877-0204
Mailing Address - Fax:
Practice Address - Street 1:4905 LESTER RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-7129
Practice Address - Country:US
Practice Address - Phone:850-877-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL342169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist