Healthcare Provider Details

I. General information

NPI: 1205450095
Provider Name (Legal Business Name): MADELINE ROSE KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MERIDIAN AVE N STE G11
SEATTLE WA
98133-9008
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-2000
  • Fax: 206-901-2010
Mailing address:
  • Phone: 206-901-2000
  • Fax: 206-901-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC70168657
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: