Organization
KATIES WAY DUPONT
Active
Parent organization
KATIES WAY TACOMA, LLC
Other names
Katies Way
Organization subpart
Yes
Provider details
NPI number
Legal business name
KATIES WAY TACOMA, LLC
Authorized official
KELLY RAE JOHNSON (CREDENTIALING DIRECTOR)
(785) 320-6616
Entity
Organization
Contact information
Practice address
1175 CENTER DR STE 130, DUPONT, WA 98327-7733
(253) 260-6521
(253) 397-3443
Mailing address
1175 CENTER DR STE 130, DUPONT, WA 98327-7733
(253) 260-6521
(253) 397-3443
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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