Provider Demographics
NPI:1417335936
Name:KANDOLA, HARLEEN
Entity Type:Individual
Prefix:
First Name:HARLEEN
Middle Name:
Last Name:KANDOLA
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 1:15815 SE 240TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4109
Mailing Address - Country:US
Mailing Address - Phone:206-859-1731
Mailing Address - Fax:
Practice Address - Street 1:15815 SE 240TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4109
Practice Address - Country:US
Practice Address - Phone:206-859-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603504844171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter