Provider Demographics
NPI:1417138579
Name:KORTH, CATHI A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CATHI
Middle Name:A
Last Name:KORTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKESDALE AVE SW
Mailing Address - Street 2:SUITE #104
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-207-5322
Mailing Address - Fax:
Practice Address - Street 1:600 OAKESDALE AVE SW
Practice Address - Street 2:SUITE #104
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:253-396-1634
Practice Address - Fax:253-396-1663
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60078002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical