Provider Demographics
NPI:1023281227
Name:KATHREN, ELLEN SCHAFFER (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SCHAFFER
Last Name:KATHREN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MMED, MSW
Mailing Address - Street 1:10505 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8613
Mailing Address - Country:US
Mailing Address - Phone:509-378-5553
Mailing Address - Fax:
Practice Address - Street 1:10505 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8613
Practice Address - Country:US
Practice Address - Phone:509-378-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WA1041C0700X
WALW60807784104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2123667Medicaid