Provider Demographics
NPI:1982434932
Name:EDOLE, KENNIA RUANA
Entity type:Individual
Prefix:
First Name:KENNIA
Middle Name:RUANA
Last Name:EDOLE
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 1:2101 SW SUNSET BLVD APT C104
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-6102
Mailing Address - Country:US
Mailing Address - Phone:206-900-5236
Mailing Address - Fax:
Practice Address - Street 1:2101 SW SUNSET BLVD APT C104
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-6102
Practice Address - Country:US
Practice Address - Phone:206-900-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician