Provider Demographics
NPI:1144614371
Name:WILLOTT, KATIE (MA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WILLOTT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MYERS-WIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 36TH ST STE 275
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6580
Mailing Address - Country:US
Mailing Address - Phone:206-483-6889
Mailing Address - Fax:
Practice Address - Street 1:2722 EASTLAKE AVE E STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3143
Practice Address - Country:US
Practice Address - Phone:206-483-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WAMC60517768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health