Provider Demographics
NPI:1528472537
Name:DR.KATIE EASTMAN, INC.
Entity type:Organization
Organization Name:DR.KATIE EASTMAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LICSW
Authorized Official - Phone:360-873-8662
Mailing Address - Street 1:1909 SKYLINE WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2992
Mailing Address - Country:US
Mailing Address - Phone:360-873-8662
Mailing Address - Fax:207-433-1133
Practice Address - Street 1:1909 SKYLINE WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2992
Practice Address - Country:US
Practice Address - Phone:360-873-8662
Practice Address - Fax:207-433-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602348101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1780838912OtherINDIVIDUAL PRACTITIONER NPI