Individual
DR. KATHERINE JANE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
9040 JACKSON AVENUE, TACOMA, WA 98531
(425) 757-2920
Mailing address
14900 INTERURBAN AVE S STE 271, TUKWILA, WA 98168-4654
(425) 757-2920
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY60563485
WA
103TC1900X
Counseling Psychologist
102699
NC
103TC1900X
Counseling Psychologist
PY60563485
WA
103TH0100X
Health Service Psychologist
1070
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1070
—
SC
Enumeration date
08/20/2007
Last updated
03/13/2019
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