MEDICARE: HESUSA MARIE KROLL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477995967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HESUSA MARIE KROLL

Provider Business Mailing Address
First Line	:	1600 E OLIVE ST
Second Line	:	SOUND MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98122-2735
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	9706 4TH AVE NE STE 303
Second Line	:	NORTHGATE
City	:	SEATTLE
State	:	WA
Zip	:	98115-2199
Country	:	US
Telephone Number	:	206-302-2900
Fax Number	:	206-302-2910

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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