Provider Demographics
NPI:1639947450
Name:MICHALAK, KATHERINE KUMIKO
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KUMIKO
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:KUMIKO
Other - Last Name:MICHALAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 N HOWARD ST STE W
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 5TH AVE S APT F201
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-9016
Practice Address - Country:US
Practice Address - Phone:206-705-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA614809291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical