Provider Demographics
NPI:1750476032
Name:MACLENNAN, CATHERINE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:A
Last Name:MACLENNAN
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:PO BOX A
Mailing Address - Street 2:104 S MAIN ST UNIT A
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0960
Mailing Address - Country:US
Mailing Address - Phone:509-826-5615
Mailing Address - Fax:509-463-4699
Practice Address - Street 1:127 NORTH ASH STREET
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-826-5615
Practice Address - Fax:509-463-4699
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128671Medicaid
VA0195442OtherL&I PROVIDER NUMBER
VA8852823Medicare ID - Type UnspecifiedMEDICARE ID