Provider Demographics
NPI:1275601031
Name:SMITH, KELLI ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 SE EVERETT MALL WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2833
Mailing Address - Country:US
Mailing Address - Phone:425-609-5512
Mailing Address - Fax:425-609-5506
Practice Address - Street 1:1031 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2833
Practice Address - Country:US
Practice Address - Phone:425-609-5512
Practice Address - Fax:425-609-5506
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional