Provider Demographics
NPI:1003677238
Name:HABERMAN, KAILYN NYCOL (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:NYCOL
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 SEATTLE HILL RD APT EE3
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4104
Mailing Address - Country:US
Mailing Address - Phone:920-728-7089
Mailing Address - Fax:
Practice Address - Street 1:1621 SEATTLE HILL RD APT EE3
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-4104
Practice Address - Country:US
Practice Address - Phone:920-728-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC614153821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical