=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538610282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHLEEN UNTERREINER LICSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2016
-----------------------------------------------------
Last Update Date | 10/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3261 SW AVALON WAY APT 411
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-451-1155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3261 SW AVALON WAY APT 411
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-451-1155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. KATHLEEN YOUNG UNTERREINER
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 206-451-1155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LW 60196792
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------