Provider Demographics
NPI:1548036619
Name:INGOLD, KATIE LYNN
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:LYNN
Last Name:INGOLD
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 1:301 SMITH DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4131
Mailing Address - Country:US
Mailing Address - Phone:724-779-2010
Mailing Address - Fax:724-779-2011
Practice Address - Street 1:301 SMITH DR STE 3
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-4131
Practice Address - Country:US
Practice Address - Phone:724-779-2010
Practice Address - Fax:724-779-2011
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN296898364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult