Provider Demographics
NPI:1578617049
Name:WOLFF, KATIE JEAN (RD CD)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JEAN
Last Name:WOLFF
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:JEAN
Other - Last Name:BRUNSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 WILLOWLAWN RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-575-8101
Mailing Address - Fax:509-577-5011
Practice Address - Street 1:2811 TIETON DRIVE
Practice Address - Street 2:YAKIMA VALLEY MEMORIAL HOSPITAL
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-575-8000
Practice Address - Fax:509-577-5011
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001858133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8462392Medicaid
WA8462392Medicaid