Provider Demographics
NPI:1619845567
Name:FJERSTAD, KATIE I (CO61274330)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:I
Last Name:FJERSTAD
Suffix:
Gender:F
Credentials:CO61274330
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 108TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-4909
Mailing Address - Country:US
Mailing Address - Phone:206-304-8403
Mailing Address - Fax:
Practice Address - Street 1:14001 108TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-4909
Practice Address - Country:US
Practice Address - Phone:206-304-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61274330101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)