Provider Demographics
NPI:1639262918
Name:EKEMO, KATHRYN ELISABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELISABETH
Last Name:EKEMO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 HIGH ST SPC C-1
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5017
Mailing Address - Country:US
Mailing Address - Phone:425-308-7982
Mailing Address - Fax:425-502-8141
Practice Address - Street 1:1223 HIGH ST SPC C-1
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5017
Practice Address - Country:US
Practice Address - Phone:425-308-7982
Practice Address - Fax:425-502-8141
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11535858OtherCAQH