Healthcare Provider Details

I. General information

NPI: 1376987420
Provider Name (Legal Business Name): KATRINA HIGGINS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 ALDER AVE SUITE 207
SUMNER WA
98390-1401
US

IV. Provider business mailing address

920 ALDER AVE SUITE 207
SUMNER WA
98390-1401
US

V. Phone/Fax

Practice location:
  • Phone: 253-230-7919
  • Fax: 253-883-3535
Mailing address:
  • Phone: 253-230-7919
  • Fax: 253-883-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number60116078
License Number StateWA

VIII. Authorized Official

Name: KATRINA L HIGGINS
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 253-230-7919