Provider Demographics
NPI:1831314475
Name:SANDERS, KAIRAE R
Entity Type:Individual
Prefix:
First Name:KAIRAE
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 EVERGREEN WAY STE Z154
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3889
Mailing Address - Country:US
Mailing Address - Phone:425-263-3006
Mailing Address - Fax:425-263-3007
Practice Address - Street 1:9930 EVERGREEN WAY STE Z154
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3889
Practice Address - Country:US
Practice Address - Phone:425-263-3006
Practice Address - Fax:425-263-3007
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005963101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)