Provider Demographics
NPI:1255907440
Name:CORREA, KRYSTAL (MSW)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:CORREA
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 1:3905 S BRANDON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-6129
Mailing Address - Country:US
Mailing Address - Phone:480-310-8590
Mailing Address - Fax:
Practice Address - Street 1:3905 S BRANDON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-6129
Practice Address - Country:US
Practice Address - Phone:480-310-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC608798841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical