Paulina A. Kisselev, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

00003944 Issued in WA

Practice address

1711 12TH Ave
Seattle, WA 98122-2435

Phone

(206) 226-2715

NPI assigned

Dec 2, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228176000000",
    "number": "1831334069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 12TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981222435",
            "telephone_number": "206-226-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 12TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981222435",
            "telephone_number": "206-226-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSELEV",
        "first_name": "PAULINA",
        "middle_name": "A.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-02",
        "last_updated": "2008-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "00003944",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "00003944",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sudevi Kish, LMP
• Adrienne Marie Kishi
• Jeremy Kiskadden, M.A.
• Sara M Kisko, MA, LMHCA
• Mikhail Kisselev, N.D., L.M.P.
• Joyce Kisubi-Muyanja
• Allison Marie Kit, PHARMD
• Kenna Kita, RD
• Mariko Kita, MD
• Mari M Kitahata, MD

• Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.