Provider Demographics
NPI:1508562497
Name:KULP, ELISA LEDESKY (MSW)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:LEDESKY
Last Name:KULP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:JORDAN
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 257
Mailing Address - Street 2:R.M.B 7950
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0257
Mailing Address - Country:US
Mailing Address - Phone:406-404-6211
Mailing Address - Fax:360-647-8336
Practice Address - Street 1:960 HARRIS AVE STE 206
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7045
Practice Address - Country:US
Practice Address - Phone:360-661-1823
Practice Address - Fax:360-647-8336
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61114437101YM0800X
WALW615608951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health