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NPI Code Detail

MEDICARE: JENNY LYNN GUTAMA KULAS LICSW

MEDICARE: JENNY LYNN GUTAMA KULAS 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
11041C0700XClinical Social WorkerLW60590581WA

General Provider Information

NPI Number : 1366813230
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY LYNN GUTAMA KULAS LICSW
Provider Business Mailing Address
First Line : PO BOX 3835
Second Line :
City : SEATTLE
State : WA
Zip : 98124-3835
Country : US
Telephone Number : 206-548-3114
Fax Number : 206-762-6355
Provider Business Practice Location Address
First Line : 2600 SW THISTLE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-3748
Country : US
Telephone Number : 206-938-1360
Fax Number : 206-935-6056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2015
Last Update Date : 03/03/2017

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