Provider Demographics
NPI:1598150575
Name:WALLACE, CATHERINE MARIA CASKA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARIA CASKA
Last Name:WALLACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:MARIA
Other - Last Name:CASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1660 S COLUMBIAN WAY # 116MHC
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-768-5428
Mailing Address - Fax:206-764-2572
Practice Address - Street 1:1660 S COLUMBIAN WAY # 116MHC
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-768-5428
Practice Address - Fax:206-764-2572
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60467844103TB0200X, 103TC0700X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy