Provider Demographics
NPI:1134516040
Name:NEAL, KATHLYN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLYN
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9812
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-9054
Mailing Address - Country:US
Mailing Address - Phone:206-630-1680
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:615 N 2ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2232
Practice Address - Country:US
Practice Address - Phone:253-237-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 60336229101YM0800X
WALW60336229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health