Provider Demographics
NPI:1104516541
Name:GLASPEY, KATHLEEN ANN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:GLASPEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:ARMENTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KATHLEEN ANN SIMMS
Mailing Address - Street 1:1021 S 1ST AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4667
Mailing Address - Country:US
Mailing Address - Phone:509-969-2343
Mailing Address - Fax:
Practice Address - Street 1:918 E MEAD AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-3720
Practice Address - Country:US
Practice Address - Phone:509-453-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WACG61445094175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator