Provider Demographics
NPI:1912780750
Name:KATHARINE DICKINSON LICSW
Entity Type:Organization
Organization Name:KATHARINE DICKINSON LICSW
Other - Org Name:KATHARINE DICKINSON LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-800-7121
Mailing Address - Street 1:3327 E MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217
Mailing Address - Country:US
Mailing Address - Phone:509-220-5939
Mailing Address - Fax:
Practice Address - Street 1:12128 N DIVISION ST PMB 2012
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-7262
Practice Address - Country:US
Practice Address - Phone:509-731-4809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1215467071Medicaid