Healthcare Provider Details

I. General information

NPI: 1760236590
Provider Name (Legal Business Name): KATHERINE ELAINE HEATH RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 JACKS LN
SOMERSET KY
42501-6152
US

IV. Provider business mailing address

67 JACKS LN
SOMERSET KY
42501-6152
US

V. Phone/Fax

Practice location:
  • Phone: 606-425-4371
  • Fax: 606-699-1669
Mailing address:
  • Phone: 270-537-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number312420
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: