Provider Demographics
NPI:1588962427
Name:SANGREY, KJERSTI MARIE (EAMP/LAC)
Entity type:Individual
Prefix:
First Name:KJERSTI
Middle Name:MARIE
Last Name:SANGREY
Suffix:
Gender:F
Credentials:EAMP/LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12526 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4415
Mailing Address - Country:US
Mailing Address - Phone:206-973-7876
Mailing Address - Fax:
Practice Address - Street 1:1818 WESTLAKE AVE N
Practice Address - Street 2:SUITE 126
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2777
Practice Address - Country:US
Practice Address - Phone:206-973-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60204146171100000X
WAMA60055390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist