Healthcare Provider Details

I. General information

NPI: 1134982168
Provider Name (Legal Business Name): RAVEN VROLYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 YAUGER WAY SW
OLYMPIA WA
98502-8660
US

IV. Provider business mailing address

1112 CHESTNUT ST SE APT 301
OLYMPIA WA
98501-7326
US

V. Phone/Fax

Practice location:
  • Phone: 360-878-8248
  • Fax:
Mailing address:
  • Phone: 360-549-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61652443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: