Provider Demographics
NPI:1003064817
Name:BOTELLE WOLHART, KATHARINE MARGARET (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:MARGARET
Last Name:BOTELLE WOLHART
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26910 92ND AVE NW STE C5-203
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-5437
Mailing Address - Country:US
Mailing Address - Phone:360-926-5647
Mailing Address - Fax:
Practice Address - Street 1:410 W. BAKERVIEW RD. SUITE 110
Practice Address - Street 2:OFFICE 110
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9822
Practice Address - Country:US
Practice Address - Phone:360-926-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALW000095831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health