Provider Demographics
NPI:1396961504
Name:ROSS-KIDDER, KATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:ROSS-KIDDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 MADISON RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3380
Mailing Address - Country:US
Mailing Address - Phone:540-727-1144
Mailing Address - Fax:
Practice Address - Street 1:763 MADISON RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3380
Practice Address - Country:US
Practice Address - Phone:540-727-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000074103TS0200X
VA0810004382103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool