Provider Demographics
NPI:1629519152
Name:HARVEY, KATHYH (MS RDN CSR)
Entity Type:Individual
Prefix:
First Name:KATHYH
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MS RDN CSR
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:SCHIRO
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RDN CSR
Mailing Address - Street 1:21309 44TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3507
Mailing Address - Country:US
Mailing Address - Phone:425-744-1095
Mailing Address - Fax:425-775-1144
Practice Address - Street 1:21309 44TH AVE W
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-3507
Practice Address - Country:US
Practice Address - Phone:425-744-1095
Practice Address - Fax:425-775-1144
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001384133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8295750Medicaid