Provider Demographics
NPI:1205056439
Name:MATKOSKI, KATHLEEN MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:MATKOSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:WETHERBEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:19221 36TH AVENUE W.
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-744-0890
Mailing Address - Fax:425-482-1274
Practice Address - Street 1:19221 36TH AVENUE W.
Practice Address - Street 2:SUITE 207
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-744-0890
Practice Address - Fax:425-482-1274
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002407103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1299WEOtherREGENCE BLUESHIELD PIN #