Provider Demographics
NPI:1053075598
Name:KITTRELL, NICOLETTE BARBARA
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:BARBARA
Last Name:KITTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BOREN AVE STE 1800
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3544
Mailing Address - Country:US
Mailing Address - Phone:206-744-9657
Mailing Address - Fax:206-744-9914
Practice Address - Street 1:901 BOREN AVE STE 1800
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3544
Practice Address - Country:US
Practice Address - Phone:206-744-9657
Practice Address - Fax:206-744-9914
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical