Provider Demographics
NPI:1427420918
Name:EGGEN, KRISTY L (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:L
Last Name:EGGEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:L
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:401 BROADWAY # 91731
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3900
Mailing Address - Country:US
Mailing Address - Phone:253-331-8021
Mailing Address - Fax:833-242-1611
Practice Address - Street 1:401 BROADWAY # 91731
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3900
Practice Address - Country:US
Practice Address - Phone:253-331-8021
Practice Address - Fax:833-242-1611
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 604821451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical