Provider Demographics
NPI:1912388059
Name:PADDOCK, CATHERINE JENNIFER (MA, MAC)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:JENNIFER
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:MA, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 BLAKELY DR
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1160
Mailing Address - Country:US
Mailing Address - Phone:360-202-5363
Mailing Address - Fax:360-678-3636
Practice Address - Street 1:4601 BLAKELY DR
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1160
Practice Address - Country:US
Practice Address - Phone:360-202-5363
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00136101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)