Provider Demographics
NPI:1205410180
Name:KOSSOW, KYLA L
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:L
Last Name:KOSSOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:L
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4100 194TH ST SW STE 100
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 194TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4613
Practice Address - Country:US
Practice Address - Phone:253-259-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician