Provider Demographics
NPI:1639411382
Name:SMITH, KRISTIN NICOLE WILKINSON (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE WILKINSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 NE 20TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2054
Mailing Address - Country:US
Mailing Address - Phone:425-830-6397
Mailing Address - Fax:
Practice Address - Street 1:13010 NE 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2054
Practice Address - Country:US
Practice Address - Phone:425-830-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst