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NPI Code Detail

MEDICARE: KIRSTEN ROSE HALLSTROM HENEBRY PSYD

MEDICARE: KIRSTEN ROSE HALLSTROM HENEBRY PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY60736474WA

General Provider Information

NPI Number : 1285150979
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN ROSE HALLSTROM HENEBRY PSYD
Provider Business Mailing Address
First Line : 15214 AURORA AVE N
Second Line :
City : SHORELINE
State : WA
Zip : 98133-6143
Country : US
Telephone Number : 206-518-9021
Fax Number : 415-252-7176
Provider Business Practice Location Address
First Line : 15214 AURORA AVE N
Second Line :
City : SHORELINE
State : WA
Zip : 98133-6143
Country : US
Telephone Number : 206-518-9021
Fax Number : 415-252-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2017
Last Update Date : 10/17/2025

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