Healthcare Provider Details

I. General information

NPI: 1124271341
Provider Name (Legal Business Name): KAROL LEA PARKER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 12TH AVE S
SEATTLE WA
98144-1910
US

IV. Provider business mailing address

PO BOX 400 SOLDIER CREEK ROAD
ROSEBUD SD
57570-0400
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-9360
  • Fax:
Mailing address:
  • Phone: 605-747-2231
  • Fax: 605-747-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07665
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: