Provider Demographics
NPI:1063989457
Name:DORMAN, KATE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:DORMAN
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 1:546 NE RAVENNA BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6479
Mailing Address - Country:US
Mailing Address - Phone:630-254-0596
Mailing Address - Fax:
Practice Address - Street 1:546 NE RAVENNA BLVD APT 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6479
Practice Address - Country:US
Practice Address - Phone:425-739-5375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 390200000X
WASC609502811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program