Provider Demographics
NPI:1639500580
Name:KIESER, AMANDA (BA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:KIESER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 20TH AVE S
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2967
Mailing Address - Country:US
Mailing Address - Phone:360-434-5753
Mailing Address - Fax:
Practice Address - Street 1:2329 4TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1717
Practice Address - Country:US
Practice Address - Phone:206-461-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG 60393424OtherCOUNSELOR AGENCY AFFILIATED