Provider Demographics
NPI:1972626034
Name:WEISS, KRISTY JEAN (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:JEAN
Last Name:WEISS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:JEAN
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0480
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:11821 NE 128TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7210
Practice Address - Country:US
Practice Address - Phone:425-285-1250
Practice Address - Fax:425-285-1255
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WAMA60558965225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor