Provider Demographics
NPI:1184342552
Name:HIATT, KARLYN
Entity type:Individual
Prefix:
First Name:KARLYN
Middle Name:
Last Name:HIATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29523 SE 208TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-7805
Mailing Address - Country:US
Mailing Address - Phone:206-930-3557
Mailing Address - Fax:
Practice Address - Street 1:208 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-3812
Practice Address - Country:US
Practice Address - Phone:206-930-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61308086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health