Provider Demographics
NPI:1255068862
Name:KALVIG, JESSICA (MSW, LSWAIC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KALVIG
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:FOX
Other - Middle Name:
Other - Last Name:KALVIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSWAIC
Mailing Address - Street 1:413 NE 70TH ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5485
Mailing Address - Country:US
Mailing Address - Phone:815-276-9099
Mailing Address - Fax:
Practice Address - Street 1:413 NE 70TH ST UNIT 309
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5485
Practice Address - Country:US
Practice Address - Phone:815-276-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611558921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical