Provider Demographics
NPI:1982169504
Name:WETZEL, KAITLYN TIARA
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:TIARA
Last Name:WETZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 NW BUCKLIN HILL RD STE 224
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8365
Mailing Address - Country:US
Mailing Address - Phone:360-536-3060
Mailing Address - Fax:
Practice Address - Street 1:3100 NW BUCKLIN HILL RD STE 224
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8365
Practice Address - Country:US
Practice Address - Phone:360-536-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician