Healthcare Provider Details

I. General information

NPI: 1063989457
Provider Name (Legal Business Name): KATE DORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 NE RAVENNA BLVD APT 201
SEATTLE WA
98115-6479
US

IV. Provider business mailing address

546 NE RAVENNA BLVD APT 201
SEATTLE WA
98115-6479
US

V. Phone/Fax

Practice location:
  • Phone: 425-739-5375
  • Fax:
Mailing address:
  • Phone: 630-254-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61327931
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: