Healthcare Provider Details

I. General information

NPI: 1205486990
Provider Name (Legal Business Name): KRISTEN MARIE HEPWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EASY ST
WENATCHEE WA
98801-5903
US

IV. Provider business mailing address

218 CHATHAM HILL RD
WENATCHEE WA
98801-5930
US

V. Phone/Fax

Practice location:
  • Phone: 360-984-3131
  • Fax:
Mailing address:
  • Phone: 360-599-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39937
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: