Provider Demographics
NPI:1285023069
Name:MCKINZEY-BARTELMIE, KAMI (SUDP)
Entity Type:Individual
Prefix:MRS
First Name:KAMI
Middle Name:
Last Name:MCKINZEY-BARTELMIE
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-1299
Mailing Address - Country:US
Mailing Address - Phone:360-989-4890
Mailing Address - Fax:360-397-7477
Practice Address - Street 1:21810 NE 37TH AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7747
Practice Address - Country:US
Practice Address - Phone:360-989-4890
Practice Address - Fax:360-397-7477
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60145174101YA0400X
WABHA.FS.61070865101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2166178Medicaid