Healthcare Provider Details

I. General information

NPI: 1922118520
Provider Name (Legal Business Name): KATHERINE RATHBURN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E 7TH ST
HAYS KS
67601-4139
US

IV. Provider business mailing address

208 E 7TH ST
HAYS KS
67601-4139
US

V. Phone/Fax

Practice location:
  • Phone: 785-628-2871
  • Fax: 785-628-0330
Mailing address:
  • Phone: 785-628-2871
  • Fax: 785-628-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1644
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberFLP1335
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: