Provider Demographics
NPI:1669928289
Name:SONJA, KATHRYN (LSWAIC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SONJA
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1451
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-1451
Mailing Address - Country:US
Mailing Address - Phone:425-640-7009
Mailing Address - Fax:
Practice Address - Street 1:22722 29TH DR SE STE 100
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4420
Practice Address - Country:US
Practice Address - Phone:425-310-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608572294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60857294OtherSOCIAL WORK ASSOCIATE INDEPENDENT CLINICAL LICENSE