MEDICARE: DR. KATHRYN ELISABETH EKEMO PH.D.

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	103TC0700X	Clinical Psychologist	PY2096	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11535858	OTHER	WA	CAQH

General Provider Information

NPI Number	:	1639262918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN ELISABETH EKEMO PH.D.

Provider Business Mailing Address
First Line	:	1223 HIGH ST SPC C-1
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-5017
Country	:	US
Telephone Number	:	425-308-7982
Fax Number	:	425-502-8141

Provider Business Practice Location Address
First Line	:	1223 HIGH ST SPC C-1
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-5017
Country	:	US
Telephone Number	:	425-308-7982
Fax Number	:	425-502-8141

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/21/2022

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