Provider Demographics
NPI:1043630684
Name:VISITACION, KYLE A
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:VISITACION
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 1:3003 NORTHUP WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1471
Mailing Address - Country:US
Mailing Address - Phone:425-822-6442
Mailing Address - Fax:425-828-3101
Practice Address - Street 1:3003 NORTHUP WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1471
Practice Address - Country:US
Practice Address - Phone:425-822-6442
Practice Address - Fax:425-828-3101
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst