Provider Demographics
NPI:1467803023
Name:NEWELL, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:JENNIFER
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2623 EVERGREEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-1528
Mailing Address - Country:US
Mailing Address - Phone:206-369-2505
Mailing Address - Fax:
Practice Address - Street 1:2623 EVERGREEN POINT RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:WA
Practice Address - Zip Code:98039-1528
Practice Address - Country:US
Practice Address - Phone:206-369-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst