Provider Demographics
NPI:1558683177
Name:PEPPARD, KATHLEEN (MSW, LICSW, ACSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PEPPARD
Suffix:
Gender:F
Credentials:MSW, LICSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 4TH AVE E
Mailing Address - Street 2:SUITE 216
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6983
Mailing Address - Country:US
Mailing Address - Phone:360-584-5971
Mailing Address - Fax:
Practice Address - Street 1:203 4TH AVE E
Practice Address - Street 2:SUITE 216
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-6983
Practice Address - Country:US
Practice Address - Phone:360-584-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000057311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical