Provider Demographics
NPI:1942418173
Name:KATHERINE, ANNE LOUISE (MA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:KATHERINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0538
Mailing Address - Country:US
Mailing Address - Phone:360-310-0361
Mailing Address - Fax:361-678-8473
Practice Address - Street 1:627 5TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1580
Practice Address - Country:US
Practice Address - Phone:206-527-5492
Practice Address - Fax:360-678-8473
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA123306 123308OtherPREMERA BLUE CROSS
WA8852KAOtherREGENCE BLUESHIELD