Healthcare Provider Details

I. General information

NPI: 1396961504
Provider Name (Legal Business Name): KATHLEEN ROSS-KIDDER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 MADISON RD SUITE 206
CULPEPER VA
22701-3380
US

IV. Provider business mailing address

763 MADISON RD SUITE 206
CULPEPER VA
22701-3380
US

V. Phone/Fax

Practice location:
  • Phone: 540-727-1144
  • Fax:
Mailing address:
  • Phone: 540-727-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0803000074
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810004382
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: