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NPI Code Detail

MEDICARE: KIMBERLY PELTOLA LICSWA

MEDICARE: KIMBERLY PELTOLA LICSWA
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 WorkerSC60192010WA

General Provider Information

NPI Number : 1568805083
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY PELTOLA LICSWA
Provider Business Mailing Address
First Line : 905 SPRUCE ST STE 300
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2474
Country : US
Telephone Number : 206-548-3114
Fax Number : 206-762-6355
Provider Business Practice Location Address
First Line : 2600 SW THISTLE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-3748
Country : US
Telephone Number : 206-548-3114
Fax Number : 206-762-6355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2013
Last Update Date : 04/15/2013

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Directions to “ KIMBERLY PELTOLA LICSWA” Practice Location

Language Start Address Practice Location
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