Provider Demographics
NPI:1497850051
Name:SHAY, KATHLEEN A (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:SHAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:AIKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2114 MAIN ST # 100-102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2674
Mailing Address - Country:US
Mailing Address - Phone:425-272-9408
Mailing Address - Fax:
Practice Address - Street 1:2408 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2663
Practice Address - Country:US
Practice Address - Phone:425-272-9408
Practice Address - Fax:425-272-9421
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011927-01103TC0700X
WA60947355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N15720Medicare ID - Type Unspecified