Healthcare Provider Details

I. General information

NPI: 1093317406
Provider Name (Legal Business Name): KALEB JAMES VANRIJSWIJCK BA, CPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 FEDERAL AVE # 11
EVERETT WA
98203-2132
US

IV. Provider business mailing address

4526 FEDERAL AVE # 11
EVERETT WA
98203-2132
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-6200
  • Fax:
Mailing address:
  • Phone: 425-349-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61123358
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCG61123358
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: