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General NPI Number Information
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NPI Number | 1538426937
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Entity Type | Individual
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Provider Name | KRISTEN DEBELLIS MATTISSON EAMP, LMP
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Gender | Female
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 03/08/2015
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Provider Practice Location Address
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Address Line | 600 W MCGRAW ST SUITE 1
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City | SEATTLE
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State | WA
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Zip | 98119-5801
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Country | US
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Telephone | 206-282-5386
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Fax |
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Provider Business Mailing Address
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Address Line | 14210 NE 40TH PL
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City | BELLEVUE
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State | WA
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Zip | 98007-7127
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Country | US
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Telephone | 631-834-0842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60248797
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | MA60202945
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License Number State | WA
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