Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY00003761 | WA |
N | 103TC0700X | Clinical Psychologist | PY00003761 | WA |
Y | 103TR0400X | Rehabilitation Psychologist | PY00003761 | WA |
NPI | 1295972057 |
---|---|
Provider Name | Katherine Anne Raichle |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2009 |
Last Update Date | 30/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8532624 | (05) | WA |