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NPI Code Detail

MEDICARE: KATHY CONNELLY LISW

MEDICARE: KATHY CONNELLY LISW
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 WorkerLW00007606WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14371COOTHERWAREGENCE BLUESHIELD

General Provider Information

NPI Number : 1518175835
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY CONNELLY LISW
Provider Business Mailing Address
First Line : 2400 NE 95TH ST
Second Line :
City : SEATTLE
State : WA
Zip : 98115-2426
Country : US
Telephone Number : 206-525-5050
Fax Number : 206-525-9795
Provider Business Practice Location Address
First Line : 2400 NE 95TH ST
Second Line :
City : SEATTLE
State : WA
Zip : 98115-2426
Country : US
Telephone Number : 206-525-5050
Fax Number : 206-525-9795
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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Directions to “ KATHY CONNELLY LISW” Practice Location

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