Provider Demographics
NPI:1598957771
Name:WENGROFSKY, KATY FIONA (ASW 127851)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:FIONA
Last Name:WENGROFSKY
Suffix:
Gender:
Credentials:ASW 127851
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 WASHINGTON ST STE 223
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3922
Mailing Address - Country:US
Mailing Address - Phone:510-871-0034
Mailing Address - Fax:510-272-1220
Practice Address - Street 1:100 N HOWARD ST STE R
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:510-332-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA616410641041C0700X
CA127851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical