Provider Demographics
NPI:1366209389
Name:LODELL, KATELYN (MA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:LODELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 FOX SPIT RD
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9315
Mailing Address - Country:US
Mailing Address - Phone:360-320-7081
Mailing Address - Fax:
Practice Address - Street 1:5522 FREELAND AVE
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9734
Practice Address - Country:US
Practice Address - Phone:360-320-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61516324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health