Provider Demographics
NPI:1104268929
Name:NIELSEN, KARN LUELLA (CDPT)
Entity type:Individual
Prefix:
First Name:KARN
Middle Name:LUELLA
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2802
Mailing Address - Country:US
Mailing Address - Phone:509-326-7740
Mailing Address - Fax:509-326-6725
Practice Address - Street 1:1224 N ASH ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2802
Practice Address - Country:US
Practice Address - Phone:509-326-7740
Practice Address - Fax:509-326-6725
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO 60326314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)