Provider Demographics
NPI:1336425503
Name:SARTAIN, KATRINA LEE (SUDP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LEE
Last Name:SARTAIN
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 PACIFIC HIGHLANDS CT
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8610
Mailing Address - Country:US
Mailing Address - Phone:253-320-4665
Mailing Address - Fax:
Practice Address - Street 1:4210 AUBURN WAY N
Practice Address - Street 2:SUITE 2
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1393
Practice Address - Country:US
Practice Address - Phone:253-813-2011
Practice Address - Fax:253-813-9959
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60453411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)