Provider Demographics
NPI:1528111515
Name:KINDRED ASSOCIATES, PLLC
Entity type:Organization
Organization Name:KINDRED ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS
Authorized Official - Phone:360-733-3160
Mailing Address - Street 1:3915 E CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4437
Mailing Address - Country:US
Mailing Address - Phone:360-733-3160
Mailing Address - Fax:360-733-8540
Practice Address - Street 1:3915 E CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4437
Practice Address - Country:US
Practice Address - Phone:360-733-3160
Practice Address - Fax:360-733-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602560961124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8023137Medicaid
WA5902135Medicaid
WA5025036Medicaid
WA5900824Medicaid
WA5902143Medicaid