Healthcare Provider Details

I. General information

NPI: 1104303387
Provider Name (Legal Business Name): KATHERINE KIRKPATRICK LIST LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ELIZABETH KIRKPATRICK LICSW

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 CHEROKEE AVE SW STE A
CULLMAN AL
35055-5502
US

IV. Provider business mailing address

1111 WAYNE RD NW STE 6
HUNTSVILLE AL
35806-3573
US

V. Phone/Fax

Practice location:
  • Phone: 256-775-8824
  • Fax: 256-775-8830
Mailing address:
  • Phone: 256-288-3333
  • Fax: 256-288-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4161C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: