Provider Demographics
NPI:1780010298
Name:LINDBERG, CATHERINE MARIE
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARIE
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MARIE
Other - Last Name:GERVASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22500 SE 64TH PL STE 150
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8128
Mailing Address - Country:US
Mailing Address - Phone:425-409-6414
Mailing Address - Fax:425-642-8256
Practice Address - Street 1:22500 SE 64TH PL STE 150
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8128
Practice Address - Country:US
Practice Address - Phone:425-409-6414
Practice Address - Fax:425-642-8256
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60505919133N00000X
WAMC60505829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist