Provider Demographics
NPI:1285163741
Name:THEW, KENDRA RIEGER (MA, PHD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:RIEGER
Last Name:THEW
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 DRIFTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-2663
Mailing Address - Country:US
Mailing Address - Phone:206-940-9220
Mailing Address - Fax:
Practice Address - Street 1:16000 BOTHELL EVERETT HWY STE 360
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1577
Practice Address - Country:US
Practice Address - Phone:425-357-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60751837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health