Provider Demographics
NPI:1770655664
Name:YOUNG, KIRSTEN ANNA (LMP)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:ANNA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 W. CLEARWATER AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-737-0610
Mailing Address - Fax:509-737-8731
Practice Address - Street 1:3400 W CLEARWATER AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2709
Practice Address - Country:US
Practice Address - Phone:509-737-0610
Practice Address - Fax:509-737-8731
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist