Healthcare Provider Details

I. General information

NPI: 1902738438
Provider Name (Legal Business Name): DANIEL R KRESSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8239 178TH AVE SW
ROCHESTER WA
98579-9515
US

IV. Provider business mailing address

8239 178TH AVE SW
ROCHESTER WA
98579-9515
US

V. Phone/Fax

Practice location:
  • Phone: 509-280-3556
  • Fax:
Mailing address:
  • Phone: 509-280-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.70022493
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: