Basic Information
| Provider Information | |||||||||
| NPI: | 1245777242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUILERA-KUTCH | ||||||||
| FirstName: | MARLENE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1014 WALLA WALLA AVE | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988011523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096630034 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 504 ORONDO AVE | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988012830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096621269 | ||||||||
| FaxNumber: | 5096641037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2017 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LW61033434 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2093782 | 05 | WA | MEDICAID |