Provider Demographics
NPI:1043747330
Name:COOK, KATHERINE ANNE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:COOK
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:12015 MARINE DR # 713
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9306
Practice Address - Country:US
Practice Address - Phone:425-349-8471
Practice Address - Fax:425-349-8304
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1278571041C0700X
WALW611362031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2116519Medicaid