Provider Demographics
NPI:1245546100
Name:KASS, ELIAS (ND, LM, CPM)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:KASS
Suffix:
Gender:M
Credentials:ND, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 NE 125TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4565
Mailing Address - Country:US
Mailing Address - Phone:206-203-2509
Mailing Address - Fax:855-897-3364
Practice Address - Street 1:3316 NE 125TH ST STE 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4565
Practice Address - Country:US
Practice Address - Phone:206-203-2509
Practice Address - Fax:855-897-3364
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60169619176B00000X
WANT60180931175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1245546100Medicaid