Provider Demographics
NPI:1770817660
Name:THORPE, KATIJEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATIJEAN
Middle Name:
Last Name:THORPE
Suffix:
Gender:F
Credentials:LCSW
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 274
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0045
Mailing Address - Country:US
Mailing Address - Phone:360-565-6028
Mailing Address - Fax:360-323-6403
Practice Address - Street 1:9732 OLD OLYMPIC HWY
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3150
Practice Address - Country:US
Practice Address - Phone:360-565-6028
Practice Address - Fax:360-323-6403
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 600639101041C0700X
UT5300062-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA12577OtherMEDICARE NUMBER