Provider Demographics
NPI:1972838746
Name:KIPLING, MARK (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:KIPLING
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ROCKEFELLER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4046
Mailing Address - Country:US
Mailing Address - Phone:425-388-7217
Mailing Address - Fax:425-388-7216
Practice Address - Street 1:3000 ROCKEFELLER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4046
Practice Address - Country:US
Practice Address - Phone:425-388-7217
Practice Address - Fax:425-388-7216
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC 00011418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health