Provider Demographics
NPI:1912793100
Name:VEDITZ, KATHRYN (MFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:VEDITZ
Suffix:
Gender:
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-0216
Mailing Address - Country:US
Mailing Address - Phone:831-246-0217
Mailing Address - Fax:
Practice Address - Street 1:5905 SOQUEL DR STE 350
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2850
Practice Address - Country:US
Practice Address - Phone:831-246-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42678106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist