Provider Demographics
NPI:1639113715
Name:KRATZ, LYN SPLITGABER (MSW)
Entity Type:Individual
Prefix:MS
First Name:LYN
Middle Name:SPLITGABER
Last Name:KRATZ
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 1:5400 CALIFORNIA AVE SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1501
Mailing Address - Country:US
Mailing Address - Phone:206-935-7407
Mailing Address - Fax:206-932-0401
Practice Address - Street 1:5400 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1501
Practice Address - Country:US
Practice Address - Phone:206-935-7407
Practice Address - Fax:206-932-0401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000061661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00006166OtherLICSW