Provider Demographics
NPI:1962835082
Name:SMALL, KATHERINE (MS, LCGC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:KAERCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCGC
Mailing Address - Street 1:2055 ARBOR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-1849
Mailing Address - Country:US
Mailing Address - Phone:062-624-0444
Mailing Address - Fax:
Practice Address - Street 1:4140 W MEMORIAL RD STE 321
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8300
Practice Address - Country:US
Practice Address - Phone:405-748-4726
Practice Address - Fax:405-936-5621
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK190170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS