Provider Demographics
NPI:1780119982
Name:KITZING, KATHRYN CORINNE (CP60324554; MC608611)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:CORINNE
Last Name:KITZING
Suffix:
Gender:F
Credentials:CP60324554; MC608611
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3441
Mailing Address - Country:US
Mailing Address - Phone:253-553-7231
Mailing Address - Fax:
Practice Address - Street 1:390 E SUNSET WAY
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3441
Practice Address - Country:US
Practice Address - Phone:253-553-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60324554101YA0400X
WALH61069288101YM0800X
WAMC60861137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)