Provider Demographics
NPI:1386789469
Name:LEDLIE, KATHERINE ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:LEDLIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CLIFF FALLS CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-8025
Mailing Address - Country:US
Mailing Address - Phone:719-526-1191
Mailing Address - Fax:
Practice Address - Street 1:6541 SPECKER AVE
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4263
Practice Address - Country:US
Practice Address - Phone:719-503-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY-3366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2865887Medicaid
CP33311Medicare PIN