Provider Demographics
NPI:1871184416
Name:FREEMAN, KATHERINE A
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N TACOMA AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2626
Mailing Address - Country:US
Mailing Address - Phone:360-608-4667
Mailing Address - Fax:
Practice Address - Street 1:2615 N 29TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6318
Practice Address - Country:US
Practice Address - Phone:206-769-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604533516174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist