Provider Demographics
NPI:1083072201
Name:PAYNE, KATELYN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ANN
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 CEDAR ST APT 909
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-5209
Mailing Address - Country:US
Mailing Address - Phone:608-577-2344
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 428
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3392
Practice Address - Country:US
Practice Address - Phone:206-402-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608131701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical