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General NPI Number Information
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NPI Number | 1336891373
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Entity Type | Organization
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Legal Business Name | KATHRYN HOSTETTLER LICENSED CLINICAL SOCIAL WORKER WELLNESS, INC.
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 7113 OAKDALE AVE
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City | WINNETKA
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State | CA
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Zip | 91306-3627
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Country | US
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Telephone | 609-356-8643
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Fax |
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Provider Business Mailing Address
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Address Line | 7113 OAKDALE AVE
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City | WINNETKA
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State | CA
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Zip | 91306-3627
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Country | US
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Telephone | 609-356-8643
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHRYN HOSTETTLER
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Credential | MSW
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Telephone | 609-356-8643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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