Healthcare Provider Details

I. General information

NPI: 1780180737
Provider Name (Legal Business Name): KATELYN G PREG AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CASCADE PL STE 110
BURLINGTON WA
98233-3126
US

IV. Provider business mailing address

11627 AIRPORT RD STE B
EVERETT WA
98204-8714
US

V. Phone/Fax

Practice location:
  • Phone: 425-864-5226
  • Fax: 425-263-9706
Mailing address:
  • Phone: 425-864-5226
  • Fax: 425-263-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60790366
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: