Provider Demographics
NPI:1346944253
Name:MILLER, KRISTIE MARIE KOPP (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE KOPP
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 ADAMS CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8212
Mailing Address - Country:US
Mailing Address - Phone:425-445-5203
Mailing Address - Fax:
Practice Address - Street 1:1075 ADAMS CT
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-8212
Practice Address - Country:US
Practice Address - Phone:425-445-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000092791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical