Provider Demographics
NPI:1396486189
Name:REIDELL, KALENE NOELLE
Entity type:Individual
Prefix:
First Name:KALENE
Middle Name:NOELLE
Last Name:REIDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALENE
Other - Middle Name:NOELLE
Other - Last Name:BUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5610 KITSAP WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2266
Mailing Address - Country:US
Mailing Address - Phone:360-792-2020
Mailing Address - Fax:
Practice Address - Street 1:5610 KITSAP WAY STE 320
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2266
Practice Address - Country:US
Practice Address - Phone:360-792-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61283691101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor