Healthcare Provider Details

I. General information

NPI: 1932565017
Provider Name (Legal Business Name): KATIJEAN THORPE, MSW, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
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

VII. Legacy identifiers

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

# 1
IdentifierG8914039
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerPTAN

VIII. Authorized Official

Name: KATIJEAN THORPE
Title or Position: PRESIDENT
Credential: MSW
Phone: 360-565-6028