Healthcare Provider Details

I. General information

NPI: 1962840413
Provider Name (Legal Business Name): KATHERINE JANELLE WILSON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 CARLSBORG RD STE C
SEQUIM WA
98382-6710
US

IV. Provider business mailing address

1400 WASHINGTON RD STE 104
SEQUIM WA
98382-3681
US

V. Phone/Fax

Practice location:
  • Phone: 408-966-3312
  • Fax:
Mailing address:
  • Phone: 408-966-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC36727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: