Provider Demographics
NPI:1497535280
Name:SHILVOCK, KALISON
Entity Type:Individual
Prefix:
First Name:KALISON
Middle Name:
Last Name:SHILVOCK
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 1:528 N 188TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3815
Mailing Address - Country:US
Mailing Address - Phone:206-697-4944
Mailing Address - Fax:
Practice Address - Street 1:528 N 188TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3815
Practice Address - Country:US
Practice Address - Phone:206-697-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1932986577OtherGROUP PRACTICE NPI NUMBER