Healthcare Provider Details

I. General information

NPI: 1972103307
Provider Name (Legal Business Name): MELANIE KUOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 143RD PL SW
LYNNWOOD WA
98087-5946
US

IV. Provider business mailing address

2113 143RD PL SW
LYNNWOOD WA
98087-5946
US

V. Phone/Fax

Practice location:
  • Phone: 206-794-8178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61522063
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: