Provider Demographics
NPI:1184023939
Name:MCKITTRICK, AUSTIN (MS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:MCKITTRICK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 NE 87TH AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1989
Mailing Address - Country:US
Mailing Address - Phone:360-514-6041
Mailing Address - Fax:360-514-6074
Practice Address - Street 1:505 NE 87TH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1989
Practice Address - Country:US
Practice Address - Phone:360-514-1060
Practice Address - Fax:360-514-1065
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGP60482860170300000X
WAGT60629475170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS