Provider Demographics
NPI:1962420877
Name:KIEMELE, KEVIN L (MS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:KIEMELE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 16TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5211
Mailing Address - Country:US
Mailing Address - Phone:206-326-3000
Mailing Address - Fax:877-515-2975
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4022
Practice Address - Fax:206-598-6611
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001583231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA134944OtherLABOR & INDUSTRY
WA8338170Medicaid
WAU85778OtherBLUESHIELD
WAU85778OtherBLUESHIELD