Provider Demographics
NPI:1972762656
Name:KAELIN, RIA JADE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:RIA
Middle Name:JADE
Last Name:KAELIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 MARTIN WAY E
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5220
Mailing Address - Country:US
Mailing Address - Phone:360-561-6450
Mailing Address - Fax:360-350-0723
Practice Address - Street 1:3912 MARTIN WAY E
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5220
Practice Address - Country:US
Practice Address - Phone:360-561-6450
Practice Address - Fax:360-350-0723
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0019338174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist