Healthcare Provider Details

I. General information

NPI: 1770817660
Provider Name (Legal Business Name): KATIJEAN THORPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9732 OLD OLYMPIC HWY
SEQUIM WA
98382-3150
US

IV. Provider business mailing address

PO BOX 274
PORT ANGELES WA
98362-0045
US

V. Phone/Fax

Practice location:
  • Phone: 360-565-6028
  • Fax: 360-323-6403
Mailing address:
  • Phone: 360-565-6028
  • Fax: 360-323-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 60063910
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5300062-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierWA12577
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerMEDICARE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: