MEDICARE: KATHERINE DIANE BLENN

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	102L00000X	Psychoanalyst	130951	CA

General Provider Information

NPI Number	:	1801545728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DIANE BLENN

Provider Business Mailing Address
First Line	:	11230 GOLD EXPRESS DR # 310-274
Second Line	:
City	:	GOLD RIVER
State	:	CA
Zip	:	95670-4484
Country	:	US
Telephone Number	:	916-425-2132
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 TEMPLE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2024
Country	:	US
Telephone Number	:	916-425-2132
Fax Number	:

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

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	03/18/2022

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