Provider Demographics
NPI:1821393141
Name:BUCKMAN, KIRSTEN (MSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23403 LAKEVIEW DR
Mailing Address - Street 2:I-301
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2871
Mailing Address - Country:US
Mailing Address - Phone:425-835-0927
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356125
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6125
Practice Address - Country:US
Practice Address - Phone:206-598-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60150892104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker