Provider Demographics
NPI:1881296796
Name:LANOUETTE, KRISTINA ANN (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:LANOUETTE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8903 KEY PENINSULA HWY NW
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-9326
Mailing Address - Country:US
Mailing Address - Phone:253-260-6366
Mailing Address - Fax:253-884-2632
Practice Address - Street 1:8903 KEY PENINSULA HWY NW
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9326
Practice Address - Country:US
Practice Address - Phone:253-260-6366
Practice Address - Fax:253-884-2632
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610242931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2168524Medicaid