Provider Demographics
NPI:1265726046
Name:DOCKEN, KIRSTY MARIE (MSOM, LAC, MA SLP)
Entity type:Individual
Prefix:MS
First Name:KIRSTY
Middle Name:MARIE
Last Name:DOCKEN
Suffix:
Gender:F
Credentials:MSOM, LAC, MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 10TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1725
Mailing Address - Country:US
Mailing Address - Phone:503-544-7665
Mailing Address - Fax:
Practice Address - Street 1:706 MARKET ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3712
Practice Address - Country:US
Practice Address - Phone:253-473-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60208465171100000X
WALL00004762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist