Healthcare Provider Details

I. General information

NPI: 1255650891
Provider Name (Legal Business Name): CATHERINE A. HENDERSON PHD, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 114TH AVE SE SUITE 210
BELLEVUE WA
98004-6942
US

IV. Provider business mailing address

1300 114TH AVE SE SUITE 210
BELLEVUE WA
98004-6942
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-3136
  • Fax: 425-451-2361
Mailing address:
  • Phone: 425-454-3136
  • Fax: 425-451-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number600-363-180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: