Provider Demographics
NPI:1699182071
Name:BURROW, KIM LEE (LICSW)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LEE
Last Name:BURROW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:LEE
Other - Last Name:LARKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:13925 INTERURBAN AVE S STE 120
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5718
Mailing Address - Country:US
Mailing Address - Phone:206-948-0096
Mailing Address - Fax:
Practice Address - Street 1:325 E PIONEER
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3265
Practice Address - Country:US
Practice Address - Phone:253-697-8452
Practice Address - Fax:253-697-3730
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000096721041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical