1275904831 NPI number — KELLY TAYLOR CHRISTENSEN MSW, LICSW

Table of content: KELLY TAYLOR CHRISTENSEN MSW, LICSW (NPI 1275904831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275904831 NPI number — KELLY TAYLOR CHRISTENSEN MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTENSEN
Provider First Name:
KELLY
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275904831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13540 23RD PL NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98125-3325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-409-7014
Provider Business Mailing Address Fax Number:
206-341-1915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 9TH AVE
Provider Second Line Business Practice Location Address:
C2-HEM
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-2756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-223-6954
Provider Business Practice Location Address Fax Number:
206-341-1915
Provider Enumeration Date:
10/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW60160534 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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