Provider Demographics
NPI:1427352749
Name:SOUND CLINICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:SOUND CLINICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-710-3319
Mailing Address - Street 1:4810 POINT FOSDICK DR NW
Mailing Address - Street 2:PMB 27
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1711
Mailing Address - Country:US
Mailing Address - Phone:360-710-3319
Mailing Address - Fax:360-876-0878
Practice Address - Street 1:2431 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-1302
Practice Address - Country:US
Practice Address - Phone:360-710-3319
Practice Address - Fax:360-876-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1427352749Medicaid
1427352749OtherNPI