Healthcare Provider Details

I. General information

NPI: 1598338329
Provider Name (Legal Business Name): KATHERINE SKIPWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 WILLAMETTE DR NE STE A
LACEY WA
98516-1378
US

IV. Provider business mailing address

5281 SE LYNCH RD
SHELTON WA
98584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 360-878-6434
  • Fax: 844-452-1758
Mailing address:
  • Phone: 541-368-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61214356
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: