Active NPI
Kimberly Neibaur Shaw
- Counselor
- Kirkland, WA
National Provider Identifier
1578963302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG60470954
- Practice address
- 12040 98TH Ave NE
Suite 204
Kirkland, WA 98034-4290 - Phone
- (425) 658-3016
- Fax
- (425) 658-3017
- NPI assigned
- Aug 29, 2014
- Last updated
- Aug 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG60470954 | WA | Primary |
Addresses
Primary practice location
12040 98TH Ave NE
Suite 204
Kirkland, WA 98034-4290
Mailing address
12040 98TH Ave NE
Suite 204
Kirkland, WA 98034-4290
Phone (425) 658-3016
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60470954 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409270400000",
"number": "1578963302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12040 98TH AVE NE",
"address_2": "SUITE 204",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980344290",
"telephone_number": "425-658-3016",
"fax_number": "425-658-3017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12040 98TH AVE NE",
"address_2": "SUITE 204",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980344290",
"telephone_number": "425-658-3016",
"fax_number": "425-658-3017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "KIMBERLY",
"middle_name": "NEIBAUR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-29",
"last_updated": "2014-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG60470954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.