Provider Demographics
NPI:1750187860
Name:WALDREP, KATHY M (MA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:WALDREP
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 OLD PIPERS GAP RD
Mailing Address - Street 2:
Mailing Address - City:CANA
Mailing Address - State:VA
Mailing Address - Zip Code:24317-4117
Mailing Address - Country:US
Mailing Address - Phone:561-315-3698
Mailing Address - Fax:
Practice Address - Street 1:2186 OLD PIPERS GAP RD
Practice Address - Street 2:
Practice Address - City:CANA
Practice Address - State:VA
Practice Address - Zip Code:24317-4117
Practice Address - Country:US
Practice Address - Phone:561-315-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician