MEDICARE: KRISTEN LANDRESS CC

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
1	101Y00000X	Counselor	CL60959025	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CL60959025	OTHER	WA	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1346802055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LANDRESS CC

Provider Business Mailing Address
First Line	:	219 1ST AVE S STE 310
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2551
Country	:	US
Telephone Number	:	206-456-5454
Fax Number	:	206-641-3246

Provider Business Practice Location Address
First Line	:	219 1ST AVE S STE 310
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2551
Country	:	US
Telephone Number	:	206-456-5454
Fax Number	:	206-641-3246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	07/02/2019

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Directions to “ KRISTEN LANDRESS CC” Practice Location

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