Healthcare Provider Details

I. General information

NPI: 1851588032
Provider Name (Legal Business Name): ALLISON STACIA KOJICIC MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 S 188TH ST STE 200
SEATAC WA
98188-5070
US

IV. Provider business mailing address

4040 S 188TH ST STE 200
SEATAC WA
98188-5070
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-1685
  • Fax:
Mailing address:
  • Phone: 206-901-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW60667353
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4736
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60667353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: