Provider Demographics
NPI:1316445356
Name:AHLSTROM, KATHRYN (CDCA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:GALBREATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:455 E MOUND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5595
Mailing Address - Country:US
Mailing Address - Phone:614-242-1284
Mailing Address - Fax:
Practice Address - Street 1:455 E MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5595
Practice Address - Country:US
Practice Address - Phone:614-242-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.165521171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.165521OtherCHEMICAL DEPENDENCY PROFESSIONALS