Provider Demographics
NPI:1295997823
Name:HALL, KELLI K (LSWAIC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:K
Last Name:HALL
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 NE 38TH PL
Mailing Address - Street 2:SUITE 132, QUAD 1 NORTH
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7933
Mailing Address - Country:US
Mailing Address - Phone:425-202-5284
Mailing Address - Fax:206-363-9639
Practice Address - Street 1:10604 NE 38TH PL
Practice Address - Street 2:SUITE 132, QUAD 1 NORTH
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7933
Practice Address - Country:US
Practice Address - Phone:425-202-5284
Practice Address - Fax:206-363-9639
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125780104100000X
WASC60214942104100000X
WALW606771621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker