Healthcare Provider Details

I. General information

NPI: 1649780792
Provider Name (Legal Business Name): KRISTA BETH KOBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA BETH KOBE MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 NE 74TH ST
REDMOND WA
98052-7817
US

IV. Provider business mailing address

43411 SE 76TH ST
SNOQUALMIE WA
98065-9410
US

V. Phone/Fax

Practice location:
  • Phone: 425-936-1200
  • Fax:
Mailing address:
  • Phone: 206-790-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60581676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: