Individual
KIARRA YANETH MARIE BLAKELY-RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9320 112TH STREET CT SW, LAKEWOOD, WA 98498-2830
(253) 232-6079
Mailing address
9320 112TH STREET CT SW, LAKEWOOD, WA 98498-2830
(253) 232-6079
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BLAKEKY031CK
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201678489WA
—
WA
Enumeration date
09/05/2018
Last updated
09/05/2018
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