Healthcare Provider Details

I. General information

NPI: 1225437783
Provider Name (Legal Business Name): KATHERINE KELLY BEDARD THOMAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 4002
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE MLC 4002
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-9645
  • Fax: 513-636-3800
Mailing address:
  • Phone: 513-636-9645
  • Fax: 513-636-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7333
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: