Provider Demographics
NPI:1386986313
Name:SHKURKIN, EKATERINA VLADIMIROVNA (PHD, MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:VLADIMIROVNA
Last Name:SHKURKIN
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW
Other - Prefix:DR
Other - First Name:KATYA
Other - Middle Name:V
Other - Last Name:SHKURKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MSW, LCSW
Mailing Address - Street 1:3811 HAWTHORNE ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4123
Mailing Address - Country:US
Mailing Address - Phone:360-789-6248
Mailing Address - Fax:
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-789-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000052301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8934628OtherMEDICARE PTAN