Provider Demographics
NPI:1043747330
Name:COOK, KATHERINE ANNE (LICASW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:COOK
Suffix:
Gender:F
Credentials:LICASW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICASW
Mailing Address - Street 1:4526 FEDERAL AVE # MS 40
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:425-349-8471
Mailing Address - Fax:425-349-8304
Practice Address - Street 1:4526 FEDERAL AVE # MS 40
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-8471
Practice Address - Fax:425-349-8304
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60488066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health