Healthcare Provider Details

I. General information

NPI: 1477173284
Provider Name (Legal Business Name): KELSEY MAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 NE COLUMBIA RD
SEATTLE WA
98195-6062
US

IV. Provider business mailing address

PO BOX 357920
SEATTLE WA
98195-7920
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-1352
  • Fax:
Mailing address:
  • Phone: 206-616-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34245
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY61488555
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: