Healthcare Provider Details

I. General information

NPI: 1144971169
Provider Name (Legal Business Name): KATELAN LAUREN HALGREN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELAN LAUREN HEAD

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-595-3822
  • Fax: 425-257-1423
Mailing address:
  • Phone: 206-860-5414
  • Fax: 206-720-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61115370
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDI61115370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: