Provider Demographics
NPI:1124653720
Name:KVAMME, KRISTEN JANEL
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JANEL
Last Name:KVAMME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19125 N CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8035
Mailing Address - Country:US
Mailing Address - Phone:425-218-3888
Mailing Address - Fax:
Practice Address - Street 1:19125 N CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8035
Practice Address - Country:US
Practice Address - Phone:425-218-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60900265103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist