Healthcare Provider Details

I. General information

NPI: 1518601061
Provider Name (Legal Business Name): KAILEY ANNE HAWKE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAILEY ANNE IVY

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/12/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MAPLE ST
EVERETT WA
98201-3832
US

IV. Provider business mailing address

2930 MAPLE ST
EVERETT WA
98201-3832
US

V. Phone/Fax

Practice location:
  • Phone: 425-264-1500
  • Fax:
Mailing address:
  • Phone: 425-261-1500
  • Fax: 425-261-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61078452
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60875067
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: