Healthcare Provider Details

I. General information

NPI: 1326727264
Provider Name (Legal Business Name): KAYSHA MARIE COCCIA MSSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S LANE ST
SEATTLE WA
98144-2810
US

IV. Provider business mailing address

1600 S LANE ST
SEATTLE WA
98144-2810
US

V. Phone/Fax

Practice location:
  • Phone: 802-683-5236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSA61454718
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC70009453
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: