Provider Demographics
NPI:1992981500
Name:DALE, KRISTEN ANN (LMP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:DALE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6040 20TH ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2034
Mailing Address - Country:US
Mailing Address - Phone:253-922-2266
Mailing Address - Fax:253-926-3566
Practice Address - Street 1:6040 20TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98424-2034
Practice Address - Country:US
Practice Address - Phone:253-922-2266
Practice Address - Fax:253-926-3566
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0020278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist