Provider Demographics
NPI:1730115486
Name:ADDISON, KARY MELINDA (MSW)
Entity Type:Individual
Prefix:MS
First Name:KARY
Middle Name:MELINDA
Last Name:ADDISON
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 1:406 MAIN ST STE 115
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3166
Mailing Address - Country:US
Mailing Address - Phone:206-521-3644
Mailing Address - Fax:
Practice Address - Street 1:406 MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3166
Practice Address - Country:US
Practice Address - Phone:206-521-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000053161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical