Healthcare Provider Details

I. General information

NPI: 1548590946
Provider Name (Legal Business Name): KATRINA LINDAUER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CUSTER WAY SE STE D
TUMWATER WA
98501-3300
US

IV. Provider business mailing address

409 CUSTER WAY SE STE D
TUMWATER WA
98501-3300
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-7590
  • Fax:
Mailing address:
  • Phone: 360-704-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60129780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: