Provider Demographics
NPI:1649586777
Name:DRUIN, KELLY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:DRUIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DRUIN
Other - Last Name:SIEVERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 DAYTON ST STE 127
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3590
Mailing Address - Country:US
Mailing Address - Phone:206-486-0295
Mailing Address - Fax:
Practice Address - Street 1:320 DAYTON ST STE 127
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3590
Practice Address - Country:US
Practice Address - Phone:206-486-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical