Healthcare Provider Details

I. General information

NPI: 1679231930
Provider Name (Legal Business Name): MR. ROBERT LYLE KRATZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 59TH AVE SW
LAKEWOOD WA
98499-2858
US

IV. Provider business mailing address

9330 59TH AVE SW
LAKEWOOD WA
98499-2858
US

V. Phone/Fax

Practice location:
  • Phone: 253-620-5015
  • Fax: 253-620-5140
Mailing address:
  • Phone: 253-620-5015
  • Fax: 253-620-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: