Provider Demographics
NPI:1215290721
Name:KLOECK, CRISTIN JANE (LMP)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:JANE
Last Name:KLOECK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 44
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE PASS
Mailing Address - State:WA
Mailing Address - Zip Code:98068
Mailing Address - Country:US
Mailing Address - Phone:425-442-1633
Mailing Address - Fax:
Practice Address - Street 1:318 E PARK ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8200
Practice Address - Country:US
Practice Address - Phone:425-442-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2024-04-19
Deactivation Date:2017-05-26
Deactivation Code:
Reactivation Date:2024-04-19
Provider Licenses
StateLicense IDTaxonomies
WAMA00022481225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist