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NPI Code Detail

MEDICARE: MS. AMANDA KIESER BA

MEDICARE: MS. AMANDA KIESER BA
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
1251B00000XCase Management Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CG 60393424OTHERWACOUNSELOR AGENCY AFFILIATED

General Provider Information

NPI Number : 1639500580
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA KIESER BA
Provider Business Mailing Address
First Line : 1103 20TH AVE S
Second Line : UNIT 1
City : SEATTLE
State : WA
Zip : 98144-2967
Country : US
Telephone Number : 360-434-5753
Fax Number :
Provider Business Practice Location Address
First Line : 2329 4TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98121-1717
Country : US
Telephone Number : 206-461-3649
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2013
Last Update Date : 08/03/2016

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