Healthcare Provider Details

I. General information

NPI: 1164355087
Provider Name (Legal Business Name): KAITLYN NEAL MCMANUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN ALANA NEAL

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 WESTLAKE AVE N STE 303
SEATTLE WA
98109-2781
US

IV. Provider business mailing address

3012 VICTOR PL
EVERETT WA
98201-2567
US

V. Phone/Fax

Practice location:
  • Phone: 206-910-1218
  • Fax:
Mailing address:
  • Phone: 864-395-1837
  • Fax: 864-395-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: