Provider Demographics
NPI:1487036026
Name:NIEDERMEYER, KYLIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:
Last Name:NIEDERMEYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WESTLAKE AVE N STE 901
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3529
Mailing Address - Country:US
Mailing Address - Phone:253-248-4450
Mailing Address - Fax:
Practice Address - Street 1:1200 WESTLAKE AVE N STE 901
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3529
Practice Address - Country:US
Practice Address - Phone:253-248-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60865603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical