Provider Demographics
NPI:1780997668
Name:HANAUER, KATHLYN WATSON (MS, CGC)
Entity type:Individual
Prefix:MRS
First Name:KATHLYN
Middle Name:WATSON
Last Name:HANAUER
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:KATHLYN
Other - Middle Name:A
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:11111 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4676
Mailing Address - Country:US
Mailing Address - Phone:540-520-6762
Mailing Address - Fax:
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3261
Practice Address - Country:US
Practice Address - Phone:704-384-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14455170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS