Healthcare Provider Details

I. General information

NPI: 1881296796
Provider Name (Legal Business Name): KRISTINA ANN LANOUETTE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 KEY PENINSULA HWY NW
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

8903 KEY PENINSULA HWY NW
LAKEBAY WA
98349-9326
US

V. Phone/Fax

Practice location:
  • Phone: 253-260-6366
  • Fax: 253-884-2632
Mailing address:
  • Phone: 253-260-6366
  • Fax: 253-884-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW61024293
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61024293
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: