MEDICARE: KATHERINE R BREDEHOEFT PHD

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
1	103TC0700X	Clinical Psychologist	2726	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202850	OTHER	NC	COMPSYCH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	E1468	OTHER	NC	MEDCOST
4	265366	OTHER	NC	MANGED HEALTH NETWORK
5	045M3	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1558340729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE R BREDEHOEFT PHD

Provider Business Mailing Address
First Line	:	PO BOX 3711
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27515-3711
Country	:	US
Telephone Number	:	919-612-5549
Fax Number	:	910-829-9001

Provider Business Practice Location Address
First Line	:	7404 CHAPEL HILL RD STE A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5043
Country	:	US
Telephone Number	:	919-468-9444
Fax Number	:	910-829-9001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	11/08/2020

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