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NPI Code Detail

MEDICARE: KATELYNNE KETCHUM RBT

MEDICARE: KATELYNNE KETCHUM RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-21-188875AZ
2385HR2055XChild Mental Illness Respite CareAZ
3253J00000XFoster Care AgencyAZ

General Provider Information

NPI Number : 1003579384
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYNNE KETCHUM RBT
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 3480 E ROUTE 66
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-4032
Country : US
Telephone Number : 928-438-9985
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2021
Last Update Date : 03/02/2026

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Directions to “ KATELYNNE KETCHUM RBT” Practice Location

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