Healthcare Provider Details

I. General information

NPI: 1710598719
Provider Name (Legal Business Name): KENNEDY KATHERINE STOREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21727 76TH AVE W STE C
EDMONDS WA
98026-7549
US

IV. Provider business mailing address

15129 S HALTER WAY
BLUFFDALE UT
84065-1887
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-6021
  • Fax:
Mailing address:
  • Phone: 801-830-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.70023912
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12855407-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: