# LIVING WELL KENT COLLABORATIVE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Living Well Kent Collaborative
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760945968
- **Authorized official:** SHAMSO ISSAK (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (253) 457-2964

## Contact information

- **Practice address:** 515 W HARRISON ST STE 208, KENT, WA 98032-4403
- **Practice address phone:** (253) 457-2964
- **Mailing address:** 10605 SE 240TH ST \# 232, KENT, WA 98031-4903
- **Mailing address phone:** (253) 457-2964

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133NN1002X | Nutrition Education Nutritionist | — | NULL | Yes |
| 133NN1002X | Nutrition Education Nutritionist | — | — | Yes |

## Other

- **Enumeration date:** 04/13/2019
- **Last updated:** 04/13/2019