Provider Demographics
NPI:1639145915
Name:COLLIER, KIM MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 N 35TH ST STE 108E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8889
Mailing Address - Country:US
Mailing Address - Phone:206-724-5361
Mailing Address - Fax:
Practice Address - Street 1:818 12TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4410
Practice Address - Country:US
Practice Address - Phone:206-329-5255
Practice Address - Fax:206-726-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB02623Medicare ID - Type Unspecified