Basic Information
| Provider Information | |||||||||
| NPI: | 1891811212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SODERGREN | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCC/S, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 HILLSIDE DR | ||||||||
| Address2: | |||||||||
| City: | EAST PALESTINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444139758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304249573 | ||||||||
| FaxNumber: | 3304240877 | ||||||||
| Practice Location | |||||||||
| Address1: | 40722 STATE ROUTE 154 | ||||||||
| Address2: | |||||||||
| City: | LISBON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444328500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304249573 | ||||||||
| FaxNumber: | 3304240877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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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 | 101YP2500X | E0003895 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.