Provider Demographics
NPI:1538693684
Name:THOMPSON, KATHERINE (AAC CHT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:AAC CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 W REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4556
Mailing Address - Country:US
Mailing Address - Phone:360-736-1064
Mailing Address - Fax:360-736-2106
Practice Address - Street 1:2512 W REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4556
Practice Address - Country:US
Practice Address - Phone:360-736-1064
Practice Address - Fax:360-736-2106
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60702053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health