Provider Demographics
NPI:1710385067
Name:ROBERTS, KRISTIN (MA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12127 SE 160TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-5312
Mailing Address - Country:US
Mailing Address - Phone:425-331-9308
Mailing Address - Fax:
Practice Address - Street 1:7100 FORT DENT WAY STE 220
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8553
Practice Address - Country:US
Practice Address - Phone:206-708-7274
Practice Address - Fax:206-444-7810
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60704002390200000X
WAMC60624596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program