Healthcare Provider Details

I. General information

NPI: 1700695525
Provider Name (Legal Business Name): ANDREA OLMEDO-AMAYA LICSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 EVERGREEN WAY STE Z154
EVERETT WA
98204-3889
US

IV. Provider business mailing address

1618 202ND PL SW
LYNNWOOD WA
98036-7025
US

V. Phone/Fax

Practice location:
  • Phone: 425-263-3006
  • Fax:
Mailing address:
  • Phone: 206-310-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61524120
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: