Provider Demographics
NPI:1518379841
Name:HALLIWELL, AUTUMN BROOKE (LICSW)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:BROOKE
Last Name:HALLIWELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-5102
Mailing Address - Country:US
Mailing Address - Phone:206-464-6454
Mailing Address - Fax:206-652-1236
Practice Address - Street 1:216 JAMES ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-5102
Practice Address - Country:US
Practice Address - Phone:206-464-6454
Practice Address - Fax:206-652-1236
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611496861041C0700X
WASC602916651041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator