Healthcare Provider Details

I. General information

NPI: 1710316187
Provider Name (Legal Business Name): KIMARLEE KLASSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14401 NE 8TH ST
BELLEVUE WA
98007-4125
US

IV. Provider business mailing address

1917 168TH AVE NE
BELLEVUE WA
98008-2631
US

V. Phone/Fax

Practice location:
  • Phone: 425-456-6642
  • Fax:
Mailing address:
  • Phone: 425-456-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSC60223069
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: