Provider Demographics
NPI:1447644398
Name:CODDAIRE, KATELYN CHRISTINA (LP)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:CHRISTINA
Last Name:CODDAIRE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:CHRISTINA
Other - Last Name:BEALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP, CBIS
Mailing Address - Street 1:18000 STUDEBAKER RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18000 STUDEBAKER RD STE 700
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2684
Practice Address - Country:US
Practice Address - Phone:562-860-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35688103T00000X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist