Basic Information
| Provider Information | |||||||||
| NPI: | 1053043562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPANIER | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | SUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1627 WARWICK AVE | ||||||||
| Address2: | |||||||||
| City: | WHITING | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463941223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2196163387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2906 HIGHWAY AVE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463221631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2195138311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2022 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | IN | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.