Provider Demographics
NPI:1821104225
Name:SATENBERG, KIMBERLY BLAKE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BLAKE
Last Name:SATENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1747 268TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075
Mailing Address - Country:US
Mailing Address - Phone:425-557-0360
Mailing Address - Fax:
Practice Address - Street 1:310 3RD AVE NE
Practice Address - Street 2:SUITE 118
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3300
Practice Address - Country:US
Practice Address - Phone:206-853-6529
Practice Address - Fax:425-557-0360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical