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Katelyn Elizabeth Zodikoff

Counselor

Behavioral Health & Social Service Providers

1414 N California St, Stockton, CA 95202-1515

PECOS Enrollment

This provider is enrolled in PECOS as KATELYN ZODIKOFF.

Based on the most recent information from CMS, provider Katelyn Elizabeth Zodikoff is legally eligible to order and refer claims for DME services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1629418678
Provider Type
Individual
Full Name
Zodikoff, Katelyn Elizabeth
Gender
Female

Sole Proprietor
No
Enumeration Date
7/4/2013
Last Updated
2/1/2023

Contact Information

Practice Location

1414 N California St, Stockton, CA 95202-1515

(209) 468-4240

Unlisted Fax

Mailing Location

1414 N California St, Stockton, CA 95202-1515

(209) 468-4240

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License 127930 California
Code 106H00000X	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 101Y00000X	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 101YM0800X	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer

Katelyn Elizabeth Zodikoff

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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Dougherty, Daisy E.