MEDICARE: KATHERINE DURAN C061005328

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	C061005328	WA

General Provider Information

NPI Number	:	1750903365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DURAN C061005328

Provider Business Mailing Address
First Line	:	19435 68TH AVE S STE S109
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-2114
Country	:	US
Telephone Number	:	425-251-1933
Fax Number	:

Provider Business Practice Location Address
First Line	:	19435 68TH AVE S STE S109
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-2114
Country	:	US
Telephone Number	:	425-251-1933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	06/18/2020

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