Provider Demographics
NPI:1114101656
Name:KAITSCHUCK, DEBRA KAY (MC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAY
Last Name:KAITSCHUCK
Suffix:
Gender:F
Credentials:MC
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:LOFGREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC
Mailing Address - Street 1:903 NORTHUP WAY
Mailing Address - Street 2:APT A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3847
Mailing Address - Country:US
Mailing Address - Phone:425-679-6679
Mailing Address - Fax:
Practice Address - Street 1:1201 S PROCTOR ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2047
Practice Address - Country:US
Practice Address - Phone:253-396-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00058639OtherREGISTERED COUNSELOR #