Provider Demographics
NPI:1114676608
Name:KUO, SHIRLEEN L
Entity Type:Individual
Prefix:
First Name:SHIRLEEN
Middle Name:L
Last Name:KUO
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 1:23515 NE NOVELTY HILL RD STE B221
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-1996
Mailing Address - Country:US
Mailing Address - Phone:425-533-7796
Mailing Address - Fax:
Practice Address - Street 1:12519 197TH PLACE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077
Practice Address - Country:US
Practice Address - Phone:425-533-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61281923106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty