Provider Demographics
NPI:1952879454
Name:KEITH, KATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 W RIVERSIDE AVE STE 5060
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:509-609-8205
Mailing Address - Fax:
Practice Address - Street 1:522 W RIVERSIDE AVE STE 5060
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:509-609-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60305736101Y00000X
WALW609359951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor