Provider Demographics
NPI:1538561386
Name:KONG, KATHRYN (MSW, LICSW, SUDP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:MSW, LICSW, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15811 AMBAUM BLVD SW STE 110
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3071
Mailing Address - Country:US
Mailing Address - Phone:206-242-8211
Mailing Address - Fax:
Practice Address - Street 1:15811 AMBAUM BLVD SW STE 110
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3071
Practice Address - Country:US
Practice Address - Phone:206-242-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WACO61043208390200000X
WASC61068036101Y00000X
WALW615101551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor