Provider Demographics
NPI:1689408395
Name:BURNETT, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 SR-43
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241
Mailing Address - Country:US
Mailing Address - Phone:440-452-6179
Mailing Address - Fax:
Practice Address - Street 1:9217 SR-43
Practice Address - Street 2:STE 220
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241
Practice Address - Country:US
Practice Address - Phone:330-422-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator