Healthcare Provider Details

I. General information

NPI: 1053075598
Provider Name (Legal Business Name): NICOLETTE BARBARA KITTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE STE 1800
SEATTLE WA
98104-3544
US

IV. Provider business mailing address

901 BOREN AVE STE 1800
SEATTLE WA
98104-3544
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9657
  • Fax: 206-744-9914
Mailing address:
  • Phone: 206-744-9657
  • Fax: 206-744-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: