Healthcare Provider Details

I. General information

NPI: 1538634530
Provider Name (Legal Business Name): KATIE J. FOX, MSW, LICSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 W GRANDRIDGE BLVD STE 200
KENNEWICK WA
99336-1678
US

IV. Provider business mailing address

8350 W GRANDRIDGE BLVD STE 200
KENNEWICK WA
99336-1678
US

V. Phone/Fax

Practice location:
  • Phone: 509-528-9593
  • Fax: 509-381-7009
Mailing address:
  • Phone: 509-528-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATIE FOX
Title or Position: LICENSED SOCIAL WORKER
Credential: LICSW
Phone: 509-528-9593