Provider Demographics
NPI:1780817882
Name:KITSAP SEXUAL ASSAULT CENTER
Entity Type:Organization
Organization Name:KITSAP SEXUAL ASSAULT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-479-1788
Mailing Address - Street 1:600 KITSAP ST
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5327
Mailing Address - Country:US
Mailing Address - Phone:360-479-1788
Mailing Address - Fax:360-895-8696
Practice Address - Street 1:600 KITSAP ST
Practice Address - Street 2:SUITE 103A
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5327
Practice Address - Country:US
Practice Address - Phone:360-479-1788
Practice Address - Fax:360-895-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health