Provider Demographics
NPI:1538426937
Name:MATTISSON, KRISTEN DEBELLIS (EAMP, LMP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DEBELLIS
Last Name:MATTISSON
Suffix:
Gender:F
Credentials:EAMP, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14210 NE 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7127
Mailing Address - Country:US
Mailing Address - Phone:631-834-0842
Mailing Address - Fax:
Practice Address - Street 1:600 W MCGRAW ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-5801
Practice Address - Country:US
Practice Address - Phone:206-282-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60248797171100000X
WAMA60202945173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No173C00000XOther Service ProvidersReflexologist