MEDICARE: MRS. KAYA WYNN O'CONNOR MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW61374691	WA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1346797172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYA WYNN O'CONNOR MSW, LICSW

Provider Business Mailing Address
First Line	:	8015 SE 28TH STREET
Second Line	:	SUITE 309
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040
Country	:	US
Telephone Number	:	206-651-4729
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	8015 SE 28TH STREET
Second Line	:	SUITE 309
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040
Country	:	US
Telephone Number	:	206-444-3600
Fax Number	:	206-444-3610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	01/15/2026

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