Provider Demographics
NPI:1760727580
Name:KWAN, KATRINA (PSYD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:KWAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12061 SEABECK HWY NW
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9564
Mailing Address - Country:US
Mailing Address - Phone:650-387-2578
Mailing Address - Fax:
Practice Address - Street 1:12061 SEABECK HWY NW
Practice Address - Street 2:
Practice Address - City:SEABECK
Practice Address - State:WA
Practice Address - Zip Code:98380-9564
Practice Address - Country:US
Practice Address - Phone:650-387-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8399166-2501103G00000X
WAPY61229698103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist