Healthcare Provider Details

I. General information

NPI: 1720544422
Provider Name (Legal Business Name): COLLEEN CULLEY DEPREZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 14TH AVE S
SEATTLE WA
98108-4809
US

IV. Provider business mailing address

8801 14TH AVE S
SEATTLE WA
98108-4809
US

V. Phone/Fax

Practice location:
  • Phone: 206-766-6976
  • Fax: 206-766-6993
Mailing address:
  • Phone: 206-766-6976
  • Fax: 206-766-6993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1903292
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2103039
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61276536
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: