=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609202936
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN M PAPE PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2013
-----------------------------------------------------
Last Update Date | 12/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 19TH AVE E SUITE A
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112-6315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-328-3050
-----------------------------------------------------
Fax | 206-324-6517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 19TH AVE E SUITE A
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112-6315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-328-3050
-----------------------------------------------------
Fax | 206-324-6517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY60689536
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------