Provider Demographics
NPI:1114773595
Name:WILLABY, KATHERINE ASHLEY
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ASHLEY
Last Name:WILLABY
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:PO BOX 25884
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-0884
Mailing Address - Country:US
Mailing Address - Phone:479-640-1319
Mailing Address - Fax:
Practice Address - Street 1:1215 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1480
Practice Address - Country:US
Practice Address - Phone:505-884-4464
Practice Address - Fax:505-884-0054
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker