MEDICARE: LAUREN KINDLE MSW, LICSW

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
1	1041C0700X	Clinical Social Worker	SC60585704	WA
2	390200000X	Student in an Organized Health Care Education/Training Program	CO60594874	WA
3	1041C0700X	Clinical Social Worker	LW60906242	WA

General Provider Information

NPI Number	:	1528434511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN KINDLE MSW, LICSW

Provider Business Mailing Address
First Line	:	17317 51ST AVE S
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98188-3731
Country	:	US
Telephone Number	:	208-721-1464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 4TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-2352
Country	:	US
Telephone Number	:	415-202-5159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	12/28/2022

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