Healthcare Provider Details

I. General information

NPI: 1770611485
Provider Name (Legal Business Name): HEATHER KAZDA SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 20TH AVE SW
OLYMPIA WA
98501-2808
US

IV. Provider business mailing address

200 20TH AVE SW
OLYMPIA WA
98501-2808
US

V. Phone/Fax

Practice location:
  • Phone: 505-264-0601
  • Fax:
Mailing address:
  • Phone: 505-264-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM 5779
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM 5779
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1041C0700X
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: