Provider Demographics
NPI:1285150979
Name:HALLSTROM, KIRSTEN ROSE (PSYD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ROSE
Last Name:HALLSTROM
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15214 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6143
Mailing Address - Country:US
Mailing Address - Phone:206-518-9021
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:15214 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6143
Practice Address - Country:US
Practice Address - Phone:206-518-9021
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60736474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist