Provider Demographics
NPI:1730755505
Name:KEMLY, KATHERINE MOLLY (LICSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MOLLY
Last Name:KEMLY
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MOLLY
Other - Last Name:LEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1730 MINOR AVE STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2402
Practice Address - Country:US
Practice Address - Phone:206-320-2961
Practice Address - Fax:206-710-9013
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610737851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2180054Medicaid