Healthcare Provider Details

I. General information

NPI: 1457960221
Provider Name (Legal Business Name): KATHERINE GRACE VAN TIMMEREN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 FLANDERS DR
BATON ROUGE LA
70808-4349
US

IV. Provider business mailing address

5349 FLANDERS DR
BATON ROUGE LA
70808-4349
US

V. Phone/Fax

Practice location:
  • Phone: 225-485-0248
  • Fax:
Mailing address:
  • Phone: 225-256-1723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-1091
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: