Healthcare Provider Details

I. General information

NPI: 1609345891
Provider Name (Legal Business Name): KATHLEEN WICHLAND PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATEY WICHLAND

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CENTRAL SQ STE A
BRISTOL NH
03222-3130
US

IV. Provider business mailing address

FORT EDDY ROAD SUITE 1 / 1111
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-272-7605
  • Fax:
Mailing address:
  • Phone: 603-272-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1560
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: