Provider Demographics
NPI:1891067187
Name:KOUKOURAS, KATY DELAINE (ND)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:DELAINE
Last Name:KOUKOURAS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:209 AVENUE D
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2415
Mailing Address - Country:US
Mailing Address - Phone:360-863-2152
Mailing Address - Fax:360-863-2364
Practice Address - Street 1:209 AVENUE D
Practice Address - Street 2:SUITE 100B
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2730
Practice Address - Country:US
Practice Address - Phone:360-863-2152
Practice Address - Fax:360-863-2364
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60267372171100000X
WANT60264357175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist