Healthcare Provider Details

I. General information

NPI: 1215403274
Provider Name (Legal Business Name): KATHERINE HOSTETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 02/27/2024
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E EVERGREEN AVE
PHILADELPHIA PA
19118-2823
US

IV. Provider business mailing address

1417 BETHLEHEM PIKE
FLOURTOWN PA
19031-1904
US

V. Phone/Fax

Practice location:
  • Phone: 860-682-4714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC014962
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: