Healthcare Provider Details

I. General information

NPI: 1417138579
Provider Name (Legal Business Name): CATHI A KORTH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OAKESDALE AVE SW SUITE #104
RENTON WA
98057
US

IV. Provider business mailing address

600 OAKESDALE AVE SW SUITE #104
RENTON WA
98057
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-1634
  • Fax: 253-396-1663
Mailing address:
  • Phone: 425-207-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60078002
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: