Basic Information
| Provider Information | |||||||||
| NPI: | 1679925325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAULICK | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4105 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972084105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669071068 | ||||||||
| FaxNumber: | 4259179141 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 S WOODWORTH LOOP | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PALMER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996457457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077615800 | ||||||||
| FaxNumber: | 9077615801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2016 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 112420 | AK | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.