Provider Demographics
NPI:1336519222
Name:FRIEDMAN, KIRSTEN TINGLUM
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:TINGLUM
Last Name:FRIEDMAN
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 1:23361 W LUDVICK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9693
Mailing Address - Country:US
Mailing Address - Phone:360-509-7698
Mailing Address - Fax:
Practice Address - Street 1:569 DIVISION ST
Practice Address - Street 2:SUITE F
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4600
Practice Address - Country:US
Practice Address - Phone:360-509-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health