Provider Demographics
NPI:1245119973
Name:KAFEERO, KISAKYE
Entity type:Individual
Prefix:
First Name:KISAKYE
Middle Name:
Last Name:KAFEERO
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 1:1214 199TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8041
Mailing Address - Country:US
Mailing Address - Phone:978-715-9854
Mailing Address - Fax:
Practice Address - Street 1:1214 199TH STREET CT E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8041
Practice Address - Country:US
Practice Address - Phone:978-715-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician