MEDICARE: KATHERINE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	61582739	WA

General Provider Information

NPI Number	:	1083428700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SMITH

Provider Business Mailing Address
First Line	:	PO BOX 732
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-0027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36017 SE FISH HATCHERY RD
Second Line	:
City	:	FALL CITY
State	:	WA
Zip	:	98024-9749
Country	:	US
Telephone Number	:	425-276-1578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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Directions to “ KATHERINE SMITH ” Practice Location

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