Provider Demographics
NPI:1659682052
Name:KREPICK, MICHAEL S (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:KREPICK
Suffix:
Gender:M
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:PO BOX 359947
Mailing Address - Street 2:325 9TH AVE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-9947
Mailing Address - Country:US
Mailing Address - Phone:206-744-1631
Mailing Address - Fax:206-744-1614
Practice Address - Street 1:401 BROADWAY
Practice Address - Street 2:SUITE 2075
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-744-1631
Practice Address - Fax:206-744-1614
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601179451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical