Healthcare Provider Details

I. General information

NPI: 1669822268
Provider Name (Legal Business Name): KATIE PLEWA OLVERA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE OLVERA PSYD

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 10TH ST #214
BELLINGHAM WA
98225
US

IV. Provider business mailing address

1140 10TH ST STE 209
BELLINGHAM WA
98225-7053
US

V. Phone/Fax

Practice location:
  • Phone: 360-305-3909
  • Fax:
Mailing address:
  • Phone: 360-305-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60352628
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: