Healthcare Provider Details

I. General information

NPI: 1730084997
Provider Name (Legal Business Name): KILEY E GLIDEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 ELKHORN TRL NW
BREMERTON WA
98312-9648
US

IV. Provider business mailing address

4311 ELKHORN TRL NW
BREMERTON WA
98312-9648
US

V. Phone/Fax

Practice location:
  • Phone: 360-622-1310
  • Fax:
Mailing address:
  • Phone: 360-622-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: