MEDICARE: KRISTEN NEWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1467803023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NEWELL

Provider Business Mailing Address
First Line	:	2623 EVERGREEN POINT RD
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-1528
Country	:	US
Telephone Number	:	206-369-2505
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 EVERGREEN POINT RD
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-1528
Country	:	US
Telephone Number	:	206-369-2505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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Directions to “ KRISTEN NEWELL ” Practice Location

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