Provider Demographics
NPI:1194403717
Name:SHEAROUSE-KNUDSEN, KALIANNA F
Entity type:Individual
Prefix:
First Name:KALIANNA
Middle Name:F
Last Name:SHEAROUSE-KNUDSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALIANNA
Other - Middle Name:F
Other - Last Name:SHEAROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 7TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5779
Mailing Address - Country:US
Mailing Address - Phone:425-658-3016
Mailing Address - Fax:
Practice Address - Street 1:8725 S 212TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1921
Practice Address - Country:US
Practice Address - Phone:425-658-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician