Healthcare Provider Details

I. General information

NPI: 1659555803
Provider Name (Legal Business Name): KATHLEEN FRANCES GALLAGHER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 STEILACOOM BLVD SW WESTERN STATE HOSPITAL
TACOMA WA
98498
US

IV. Provider business mailing address

9601 STEILACOOM BLVD SW
TACOMA WA
98498
US

V. Phone/Fax

Practice location:
  • Phone: 253-961-7582
  • Fax:
Mailing address:
  • Phone: 253-761-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016628
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY00003729
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: