Provider Demographics
NPI:1407981228
Name:JACOLEV, KATHERINE MARIE (MA CFY SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:JACOLEV
Suffix:
Gender:F
Credentials:MA CFY SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CFY SLP
Mailing Address - Street 1:2122 2ND AVE N APT C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2367
Mailing Address - Country:US
Mailing Address - Phone:206-286-2322
Mailing Address - Fax:206-286-2301
Practice Address - Street 1:2919 1ST AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2329
Practice Address - Country:US
Practice Address - Phone:206-286-2322
Practice Address - Fax:206-286-2301
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7014954Medicaid