Provider Demographics
NPI:1548862436
Name:KIFA, CAROLINE KONSTANTINOVNA
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:KONSTANTINOVNA
Last Name:KIFA
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 1:7422 NE 202ND PL
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2172
Mailing Address - Country:US
Mailing Address - Phone:425-221-0020
Mailing Address - Fax:
Practice Address - Street 1:27241 SE 13TH PL
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-5961
Practice Address - Country:US
Practice Address - Phone:425-326-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician