Provider Demographics
NPI:1639885015
Name:STEWART, KATHRYN (MC61393010)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MC61393010
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 GREENWOOD AVE N APT 405
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5065
Mailing Address - Country:US
Mailing Address - Phone:978-766-9250
Mailing Address - Fax:
Practice Address - Street 1:3876 BRIDGE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7951
Practice Address - Country:US
Practice Address - Phone:206-681-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61393010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health