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NPI Code Detail

MEDICARE: KENNEDY OLIVIA FOWLE LCSW

MEDICARE: KENNEDY OLIVIA FOWLE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSWIA.SC.61311159WA

General Provider Information

NPI Number : 1205537594
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDY OLIVIA FOWLE LCSW
Provider Business Mailing Address
First Line : PO BOX 5127
Second Line :
City : EVERETT
State : WA
Zip : 98206-5127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 904 7TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98104-1132
Country : US
Telephone Number : 206-292-2249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2023
Last Update Date : 12/17/2025

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