Provider Demographics
NPI:1114521192
Name:BOLING, REGAN RAE KAMMA (LSWAIC, LSW)
Entity Type:Individual
Prefix:MRS
First Name:REGAN
Middle Name:RAE KAMMA
Last Name:BOLING
Suffix:
Gender:F
Credentials:LSWAIC, LSW
Other - Prefix:MISS
Other - First Name:REGAN
Other - Middle Name:RAE KAMMA
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11030 NE 58TH WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7506
Mailing Address - Country:US
Mailing Address - Phone:260-450-2143
Mailing Address - Fax:
Practice Address - Street 1:16521 13TH AVE W STE 112
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8513
Practice Address - Country:US
Practice Address - Phone:260-450-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61108110104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker