1306305289 NPI number — KATHRYN SUSANNE SCOTT MSW, LICSW

Table of content: KATHRYN SUSANNE SCOTT MSW, LICSW (NPI 1306305289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306305289 NPI number — KATHRYN SUSANNE SCOTT MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
KATHRYN
Provider Middle Name:
SUSANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306305289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ATTN: KATHRYN SCOTT, V3CNH
Provider Second Line Business Mailing Address:
1601 E. FOURTH PLAIN BLVD.
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-696-4061
Provider Business Mailing Address Fax Number:
360-690-0343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ATTN: KATHRYN SCOTT, V3CNH
Provider Second Line Business Practice Location Address:
1601 E. FOURTH PLAIN BLVD.
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-696-4061
Provider Business Practice Location Address Fax Number:
360-690-0343
Provider Enumeration Date:
03/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW60547187 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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