Provider Demographics
NPI:1417671959
Name:GASPER, KATHRYN DIANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIANNE
Last Name:GASPER
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 1:15824 N FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9450
Mailing Address - Country:US
Mailing Address - Phone:509-828-3063
Mailing Address - Fax:
Practice Address - Street 1:15824 N FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021-9450
Practice Address - Country:US
Practice Address - Phone:509-828-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609070571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical