Individual
CARISSA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 NW BUCKLIN HILL RD STE 224, SILVERDALE, WA 98383-8365
(360) 536-3060
Mailing address
475 W 260 N, OREM, UT 84057-1970
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CB60959065
WA
247200000X
Other Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396085718
—
UT
Enumeration date
10/28/2016
Last updated
09/16/2019
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