Provider Demographics
NPI:1598416307
Name:WIGINGTON, KATELYN ROSE
Entity type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:ROSE
Last Name:WIGINGTON
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 1:2955 232ND ST SW
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8324
Mailing Address - Country:US
Mailing Address - Phone:425-492-0140
Mailing Address - Fax:
Practice Address - Street 1:2212 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2591
Practice Address - Country:US
Practice Address - Phone:206-322-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor