Healthcare Provider Details

I. General information

NPI: 1639830227
Provider Name (Legal Business Name): KYLE MICHAEL ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 ALMIRA DR NE
BREMERTON WA
98311-8330
US

IV. Provider business mailing address

5455 ALMIRA DR NE
BREMERTON WA
98311-8330
US

V. Phone/Fax

Practice location:
  • Phone: 360-373-5031
  • Fax:
Mailing address:
  • Phone: 360-373-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC70040213
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: