Provider Demographics
NPI:1619208360
Name:BRODERICK, KATHRINE ANN (ND)
Entity Type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:ANN
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8336 NE 110TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3545
Mailing Address - Country:US
Mailing Address - Phone:206-419-8516
Mailing Address - Fax:206-315-5398
Practice Address - Street 1:4459 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7293
Practice Address - Country:US
Practice Address - Phone:206-419-8516
Practice Address - Fax:206-315-5398
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60116885175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath