Provider Demographics
NPI:1578399721
Name:GREGG, KATHERINE TRACY
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TRACY
Last Name:GREGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 NE HIGHWAY 99 STE 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8985
Mailing Address - Country:US
Mailing Address - Phone:360-726-4141
Mailing Address - Fax:360-787-4441
Practice Address - Street 1:9230 NE HIGHWAY 99 STE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8985
Practice Address - Country:US
Practice Address - Phone:360-726-4141
Practice Address - Fax:360-787-4441
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health