Provider Demographics
NPI:1063795821
Name:PRENSNER, KATHARINE ANN (LCSW, CSW)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ANN
Last Name:PRENSNER
Suffix:
Gender:F
Credentials:LCSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 COVINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1383
Mailing Address - Country:US
Mailing Address - Phone:317-793-7917
Mailing Address - Fax:
Practice Address - Street 1:5585 ERINDALE DR STE 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6969
Practice Address - Country:US
Practice Address - Phone:719-345-2424
Practice Address - Fax:719-345-2424
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099262341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN150074Medicare PIN