Provider Demographics
NPI:1346937828
Name:BOSCALJON, KRISTIN (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BOSCALJON
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3802
Mailing Address - Country:US
Mailing Address - Phone:515-720-4237
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3802
Practice Address - Country:US
Practice Address - Phone:515-720-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61422549101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor