Charlene Koutchak

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

203 4TH Ave E
Olympia, WA 98501-6983

Phone

(360) 402-0943

NPI assigned

Jan 31, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580428800000",
    "number": "1578194130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 MILROY ST SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 4TH AVE E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985016983",
            "telephone_number": "360-402-0943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1910 Black Lake Blvd SW",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985125651",
            "country_code": "US",
            "telephone_number": "360-402-0943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUTCHAK",
        "first_name": "CHARLENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-31",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Olympia, WA
• Providers in Olympia, WA by specialty
• Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.