Provider Demographics
NPI:1629930672
Name:QUACKENBUSH, KATE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:QUACKENBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 RESERVATION RD SE # 18
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-9415
Mailing Address - Country:US
Mailing Address - Phone:510-432-0531
Mailing Address - Fax:
Practice Address - Street 1:1546 RESERVATION RD SE # 18
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-9415
Practice Address - Country:US
Practice Address - Phone:510-432-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula