Provider Demographics
NPI:1932456324
Name:DESLOGES, KATHERINE S (MED, NCSP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:DESLOGES
Suffix:
Gender:F
Credentials:MED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NEWFOUND RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:NH
Mailing Address - Zip Code:03222-3813
Mailing Address - Country:US
Mailing Address - Phone:603-744-6006
Mailing Address - Fax:
Practice Address - Street 1:150 NEWFOUND RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:NH
Practice Address - Zip Code:03222-3813
Practice Address - Country:US
Practice Address - Phone:603-744-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2021-08-30
Deactivation Date:2021-03-23
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
NH127244103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist