Individual
KELLEN TAKESHI IMADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5608 17TH AVE NW # 1258, SEATTLE, WA 98107-5232
(646) 389-6232
Mailing address
5608 17TH AVE NW # 1258, SEATTLE, WA 98107-5232
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
08/28/2019
Last updated
06/23/2021
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