Provider Demographics
NPI:1285388199
Name:FORTUNE, KATLYN L
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:L
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:L
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8308 OHIO RIVER RD STE B
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-1713
Mailing Address - Country:US
Mailing Address - Phone:606-316-7200
Mailing Address - Fax:
Practice Address - Street 1:8308 OHIO RIVER RD STE B
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1713
Practice Address - Country:US
Practice Address - Phone:740-529-1201
Practice Address - Fax:740-876-8854
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.179686101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)