Individual
CARLA JANE KANIESKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3616 118TH STREET CT NW, GIG HARBOR, WA 98332-6867
(603) 692-8173
Mailing address
136 SHERIDAN RD, BREMERTON, WA 98310-2088
(440) 823-5287
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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