Healthcare Provider Details

I. General information

NPI: 1497025084
Provider Name (Legal Business Name): KATE JEANINE FREDENBERG LICSW, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 E STEVENS WAY NE
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

UNIVERSITY OF WASHINGTON BOX 354410
SEATTLE WA
98195-4410
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-5030
  • Fax: 206-543-4716
Mailing address:
  • Phone: 206-543-5030
  • Fax: 206-543-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 60312408
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 60489091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: