Provider Demographics
NPI:1639655699
Name:MORRIS, KATHLEEN BUCKNER
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BUCKNER
Last Name:MORRIS
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 1:5320 NIELSEN AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9441
Mailing Address - Country:US
Mailing Address - Phone:360-383-2293
Mailing Address - Fax:360-383-2274
Practice Address - Street 1:5320 NIELSEN AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9441
Practice Address - Country:US
Practice Address - Phone:360-383-2293
Practice Address - Fax:360-383-2274
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602480012171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty