Provider Demographics
NPI:1366213977
Name:LAUREL, KIRSTEN KOLEA
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:KOLEA
Last Name:LAUREL
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 1:421 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2643
Mailing Address - Country:US
Mailing Address - Phone:425-301-2332
Mailing Address - Fax:
Practice Address - Street 1:2320 130TH AVE NE STE 240
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1718
Practice Address - Country:US
Practice Address - Phone:425-646-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist