Provider Demographics
NPI:1295292670
Name:FIEDLER, KAILEY MICHELLE (MA, CRC)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:MICHELLE
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:MA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12838 SE 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1212
Mailing Address - Country:US
Mailing Address - Phone:425-614-1282
Mailing Address - Fax:425-614-1294
Practice Address - Street 1:12838 SE 40TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1212
Practice Address - Country:US
Practice Address - Phone:425-614-1282
Practice Address - Fax:425-614-1294
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60185923101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor