Provider Demographics
NPI:1881929016
Name:CARLSON, KATHRYN LEAH (ND, LAC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LEAH
Last Name:CARLSON
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18336 AURORA AVE N STE 105
Mailing Address - Street 2:UNIT 55072
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10519 20TH ST SE STE 1
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-4769
Practice Address - Country:US
Practice Address - Phone:425-397-4900
Practice Address - Fax:425-397-6900
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60108707171100000X
WANT60109144175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist