Provider Demographics
NPI:1457528044
Name:WEIGEL, KATHLEEN ALYCE (MSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALYCE
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ALYCE
Other - Last Name:MCDOUGALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:8902 E ALKI AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2705
Mailing Address - Country:US
Mailing Address - Phone:509-481-0513
Mailing Address - Fax:
Practice Address - Street 1:8902 E ALKI AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2705
Practice Address - Country:US
Practice Address - Phone:509-481-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601186051041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1457528044Medicaid