Provider Demographics
NPI:1851661912
Name:WALTER, KATHLEEN PATRICIA (MSW, LSWAA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:WALTER
Suffix:
Gender:F
Credentials:MSW, LSWAA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:PATRICIA
Other - Last Name:WATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 116TH AVE NE
Mailing Address - Street 2:OLIVE CREST
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5223
Mailing Address - Country:US
Mailing Address - Phone:425-462-1612
Mailing Address - Fax:425-462-9268
Practice Address - Street 1:515 116TH AVE NE
Practice Address - Street 2:OLIVE CREST
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5223
Practice Address - Country:US
Practice Address - Phone:425-462-1612
Practice Address - Fax:425-462-9268
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASA603525841041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker