Healthcare Provider Details

I. General information

NPI: 1447954300
Provider Name (Legal Business Name): KATHERINE A CHAVEZ SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0930
  • Fax: 206-323-0933
Mailing address:
  • Phone: 206-323-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberCO61322101
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: