Kathleen Ruth Davis

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61546770 Issued in WA

Practice address

118 E 8TH St
Port Angeles, WA 98362-6129

Phone

(360) 457-0431

Fax

(360) 457-0493

NPI assigned

Feb 8, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kathleen Ruth Dickinson Former name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peninsula Behavioral HealthGroup PAC ID 7416845870, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/peninsulabehavioral/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peninsula Behavioral Health

  • Community/Behavioral Health Agency
  • Port Angeles, WA
  • NPI 1760519060
  Medicare reassignment Care Compare group NPD
• Core Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Longview, WA
  • NPI 1639693781
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1093469025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626129",
            "telephone_number": "360-457-0431",
            "fax_number": "360-457-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626129",
            "telephone_number": "360-457-0431",
            "fax_number": "360-457-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KATHLEEN",
        "middle_name": "RUTH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-08",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61546770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "DICKINSON",
            "middle_name": "RUTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pamela Davick, LMHC
• David L Chance
• Anna Alicia Davis
• Danya Lyn Davis, LMP
• Darryl Davis
• McKay Jared Davis, DPM
• Davina Gail Davlin, ARNP
• Kalah Rose Dawley
• Joseph Day
• Mikayla Deberry

• Clinical Social Worker in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.