Provider Demographics
NPI:1003152992
Name:GREENY, KAITLIN MARIE KLOES
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE KLOES
Last Name:GREENY
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 1:4746 11TH AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4660
Mailing Address - Country:US
Mailing Address - Phone:206-535-8876
Mailing Address - Fax:
Practice Address - Street 1:4746 11TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4660
Practice Address - Country:US
Practice Address - Phone:205-535-8876
Practice Address - Fax:205-486-9938
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst