Healthcare Provider Details

I. General information

NPI: 1528549029
Provider Name (Legal Business Name): CALLEAGHN B KINNAMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

5770 26TH AVE NE APT 4
SEATTLE WA
98105-5535
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0933
  • Fax:
Mailing address:
  • Phone: 707-267-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: