Provider Demographics
NPI:1184664195
Name:KNUTSON-BRADAC, KARI ANN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:KARI
Middle Name:ANN
Last Name:KNUTSON-BRADAC
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 FRENCH LN NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3972
Mailing Address - Country:US
Mailing Address - Phone:360-481-5981
Mailing Address - Fax:360-867-0772
Practice Address - Street 1:3221 FRENCH LN NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-3972
Practice Address - Country:US
Practice Address - Phone:360-481-5981
Practice Address - Fax:360-867-0772
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000041321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8860253Medicare PIN