Provider Demographics
NPI:1831567064
Name:MCKITTRICK, KIMBERLY (MSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:MCKITTRICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 E MADISON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3104
Mailing Address - Country:US
Mailing Address - Phone:206-337-9899
Mailing Address - Fax:
Practice Address - Street 1:4033 E MADISON ST STE 203
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3104
Practice Address - Country:US
Practice Address - Phone:206-337-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61151036101YM0800X
WASC608908061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical