Provider Demographics
NPI:1144305962
Name:SHERMAN, KRISTEN BREWER
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BREWER
Last Name:SHERMAN
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:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12039 NE 128TH ST
Practice Address - Street 2:STE 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3030
Practice Address - Country:US
Practice Address - Phone:425-899-3140
Practice Address - Fax:425-899-3670
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002299103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8352932Medicaid
251940OtherINTERNAL ID-MOTOR VEHICLE ID
WA8352932Medicaid
S84455Medicare UPIN
AB10308Medicare ID - Type Unspecified