Provider Demographics
NPI:1952494007
Name:ELIAS, KATHLEEN A (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:ELIAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 WESTERN AVE
Mailing Address - Street 2:STE 510
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2161
Mailing Address - Country:US
Mailing Address - Phone:540-454-7112
Mailing Address - Fax:
Practice Address - Street 1:2003 WESTERN AVE
Practice Address - Street 2:STE 510
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2161
Practice Address - Country:US
Practice Address - Phone:540-454-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0940046731041C0700X
WALW 605234211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA492110Medicare PIN