Provider Demographics
NPI:1073590634
Name:ACKERMAN, KENNETH ALBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALBERT
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 MILL CREEK BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1504
Mailing Address - Country:US
Mailing Address - Phone:425-354-4342
Mailing Address - Fax:425-368-5854
Practice Address - Street 1:16000 MILL CREEK BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1504
Practice Address - Country:US
Practice Address - Phone:425-354-4342
Practice Address - Fax:425-368-5854
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist