Provider Demographics
NPI:1871654954
Name:ZIEMKE, KRISTY M (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:M
Last Name:ZIEMKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88994
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98138-2994
Mailing Address - Country:US
Mailing Address - Phone:435-770-8479
Mailing Address - Fax:
Practice Address - Street 1:6642 S 193RD PL STE N106
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-3109
Practice Address - Country:US
Practice Address - Phone:206-909-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009278101YM0800X
WAPY60547876103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2043785Medicaid