Provider Demographics
NPI:1336486059
Name:BLUM, KATHERINE RUTH (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:RUTH
Last Name:BLUM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4526 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:425-961-3775
Mailing Address - Fax:
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203
Practice Address - Country:US
Practice Address - Phone:425-961-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60889511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60889511OtherWA STATE MARRIAGE AND FAMILY THERAPY LICENSE NUMBER