KATHRYN E WALCK
Controlled Substance Registration for Practitioner


Address: 11 Pontiac Drive, Niantic, CT 06357

KATHRYN E WALCK (Credential# 1187735) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.

Business Overview

KATHRYN E WALCK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0056230. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 11 Pontiac Drive, Niantic, CT 06357. The current status is active.

Basic Information

Licensee Name KATHRYN E WALCK
Credential ID 1187735
Credential Number CSP.0056230
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 11 Pontiac Drive
Niantic
CT 06357
Business Type INDIVIDUAL
Status ACTIVE - CURRENT
Active 1
Issue Date 2013-10-15
Effective Date 2019-03-01
Expiration Date 2021-02-28
Refresh Date 2019-01-03

Other licenses

ID Credential Code Credential Type Issue Term Status
1184355 10.113758 Registered Nurse 2013-09-23 2019-12-01 - 2020-11-30 ACTIVE
1184357 12.005552 Advanced Practice Registered Nurse 2013-09-23 2019-12-01 - 2020-11-30 ACTIVE
1185666 10.113728-TEMP Registered Nurse - Temporary 2013-09-19 2013-09-19 - 2014-01-16 INACTIVE

Office Location

Street Address 11 Pontiac Drive
City Niantic
State CT
Zip Code 06357

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Olivia M Blodgett 30 Lake Ave, Niantic, CT 06357 Registered Nurse 2020-07-01 ~ 2021-06-30
Katherine S Kleczkowski P.o. Box 281, Niantic, CT 06357 Licensed Practical Nurse 2020-09-01 ~ 2021-08-31
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Competitor

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City Niantic
Zip Code 06357
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + Niantic

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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