Provider Demographics
NPI:1336332006
Name:MARCZAK, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MARCZAK
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 1:13555 BEL RED RD
Mailing Address - Street 2:STE. 205
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2397
Mailing Address - Country:US
Mailing Address - Phone:425-455-2320
Mailing Address - Fax:425-455-2473
Practice Address - Street 1:13555 BEL RED RD
Practice Address - Street 2:STE. 205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2397
Practice Address - Country:US
Practice Address - Phone:425-455-2320
Practice Address - Fax:425-455-2473
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist