Provider Demographics
NPI:1033776216
Name:GALE, KURTIS
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:
Last Name:GALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12602 109TH CT NE APT G205
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6493
Mailing Address - Country:US
Mailing Address - Phone:425-894-6747
Mailing Address - Fax:
Practice Address - Street 1:12602 109TH CT NE APT G205
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6493
Practice Address - Country:US
Practice Address - Phone:425-894-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60871599103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst