Healthcare Provider Details

I. General information

NPI: 1710670260
Provider Name (Legal Business Name): KATELYNN JOAN KISSLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 PA ROUTE 309
ALLENTOWN PA
18104-9307
US

IV. Provider business mailing address

2047 PA ROUTE 309
ALLENTOWN PA
18104-9307
US

V. Phone/Fax

Practice location:
  • Phone: 484-276-4646
  • Fax: 484-558-2998
Mailing address:
  • Phone: 484-276-4646
  • Fax: 484-558-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: