Provider Demographics
NPI:1205950060
Name:GERE, KATHY T (LICSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:T
Last Name:GERE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NEWMAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-9536
Mailing Address - Country:US
Mailing Address - Phone:360-999-8850
Mailing Address - Fax:360-482-3527
Practice Address - Street 1:411 N 3RD ST
Practice Address - Street 2:STE A3
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9536
Practice Address - Country:US
Practice Address - Phone:360-999-8850
Practice Address - Fax:360-482-3527
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW606453581041C0700X
WA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60645358OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER