Provider Demographics
NPI:1720083389
Name:CULLEN, KATHLEEN M (MSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CULLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17005 E MACMAHAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9675
Mailing Address - Country:US
Mailing Address - Phone:509-928-0299
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:STE 503
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2260
Practice Address - Country:US
Practice Address - Phone:509-343-3321
Practice Address - Fax:509-343-3323
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000064461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical