Provider Demographics
NPI:1962664276
Name:MANN, KATHLEEN A (CADC II)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:MANN
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2545 N ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6423
Mailing Address - Country:US
Mailing Address - Phone:541-883-3471
Mailing Address - Fax:541-883-3524
Practice Address - Street 1:2545 N ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6423
Practice Address - Country:US
Practice Address - Phone:541-883-3471
Practice Address - Fax:541-883-3524
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1114058898Medicaid