Provider Demographics
NPI:1144596610
Name:PIMPLETON, KENNETH RAY (MSW, C-PA, BA, SUDP)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:PIMPLETON
Suffix:
Gender:M
Credentials:MSW, C-PA, BA, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8645 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5851
Mailing Address - Country:US
Mailing Address - Phone:360-515-0070
Mailing Address - Fax:
Practice Address - Street 1:2502 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1310
Practice Address - Country:US
Practice Address - Phone:253-759-0852
Practice Address - Fax:253-752-0514
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005512101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)