Provider Demographics
NPI:1558854125
Name:POLK, CHELSEA KAI
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:KAI
Last Name:POLK
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 1:10220 214TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-7646
Mailing Address - Country:US
Mailing Address - Phone:425-898-7070
Mailing Address - Fax:
Practice Address - Street 1:18311 BOTHELL EVERETT HWY STE 260
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5233
Practice Address - Country:US
Practice Address - Phone:206-437-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst