Provider Demographics
NPI:1346018082
Name:SOTO, KATHERINE DOLORES (SW ICL)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DOLORES
Last Name:SOTO
Suffix:
Gender:F
Credentials:SW ICL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1342
Mailing Address - Country:US
Mailing Address - Phone:509-949-5832
Mailing Address - Fax:509-203-6504
Practice Address - Street 1:222 E 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1342
Practice Address - Country:US
Practice Address - Phone:509-203-6501
Practice Address - Fax:509-203-6504
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610879501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical