Healthcare Provider Details

I. General information

NPI: 1588813653
Provider Name (Legal Business Name): KATHERINE ANN CARLSON BA, CCRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-2591
  • Fax:
Mailing address:
  • Phone: 317-988-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number51922
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: