Provider Demographics
NPI:1336853894
Name:MARSH, KRISTEN (SC60653441)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:SC60653441
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 100TH ST SW STE 16
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2749
Mailing Address - Country:US
Mailing Address - Phone:253-988-7982
Mailing Address - Fax:
Practice Address - Street 1:5900 100TH ST SW STE 16
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2749
Practice Address - Country:US
Practice Address - Phone:253-988-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC612929821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical