Basic Information
| Provider Information | |||||||||
| NPI: | 1295151496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALSOM | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BCABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574014348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052622162 | ||||||||
| FaxNumber: | 6052620162 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574014348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052622162 | ||||||||
| FaxNumber: | 6052620162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2014 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0-11-4159 | SD | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.