Provider Demographics
NPI:1497025084
Name:FREDENBERG, KATE JEANINE (LICSW, CDP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:JEANINE
Last Name:FREDENBERG
Suffix:
Gender:F
Credentials:LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF WASHINGTON
Mailing Address - Street 2:BOX 354410
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-4410
Mailing Address - Country:US
Mailing Address - Phone:206-543-5030
Mailing Address - Fax:206-543-4716
Practice Address - Street 1:4060 E STEVENS WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-5030
Practice Address - Fax:206-543-4716
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 604890911041C0700X
WACP 60312408101YA0400X
WACP60312408101YA0400X
WASC602380551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)