MEDICARE: KATELYN AMICIA LIDDLE

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	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871104562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN AMICIA LIDDLE

Provider Business Mailing Address
First Line	:	1165 N 90TH ST APT 1
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-2110
Country	:	US
Telephone Number	:	270-505-2552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 N 90TH ST APT 1
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-2110
Country	:	US
Telephone Number	:	270-505-2552
Fax Number	:

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

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	06/24/2025

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Directions to “ KATELYN AMICIA LIDDLE ” Practice Location

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