Provider Demographics
NPI:1396266276
Name:SHAW, KAITLYN MARIE (MS, LM/CPM)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:MARIE
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS, LM/CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 GRAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3586
Mailing Address - Country:US
Mailing Address - Phone:360-447-8214
Mailing Address - Fax:360-639-6306
Practice Address - Street 1:2804 GRAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3586
Practice Address - Country:US
Practice Address - Phone:360-447-8214
Practice Address - Fax:360-639-6306
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA176B00000X
WAMW60783550176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty