Provider Demographics
NPI:1992109862
Name:HAENDIGES, KATHRYN LYNN (PSYD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:HAENDIGES
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 1:1856 ALFRESCO PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1860
Mailing Address - Country:US
Mailing Address - Phone:502-377-4758
Mailing Address - Fax:
Practice Address - Street 1:1941 BISHOP LN STE 711
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1937
Practice Address - Country:US
Practice Address - Phone:502-377-4758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1240103T00000X
NY016297-1103T00000X
KYPSYLIP00210710103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100355800Medicaid