Provider Demographics
NPI:1649612508
Name:SLAGLE, KIMBERLY ANNE (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:GOOKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 7TH AVE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1397
Mailing Address - Country:US
Mailing Address - Phone:206-357-8483
Mailing Address - Fax:
Practice Address - Street 1:1700 7TH AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1397
Practice Address - Country:US
Practice Address - Phone:206-357-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-20
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60494036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist