Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1793 | TN |
NPI | 1194994483 |
---|---|
Provider Name | Susan Pate Kavkewitz |
First Address | Chattanooga, TN 37421-7015 |
Second Address | Chattanooga, TN 37421-7015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2008 |
Last Update Date | 21/02/2008 |