Provider Demographics
NPI:1982070868
Name:KETCHUM, OLGA MARRIE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:MARRIE
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:MARRIE
Other - Middle Name:TREYGER
Other - Last Name:KETCHUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:12600 SE 38TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6105
Mailing Address - Country:US
Mailing Address - Phone:206-330-8880
Mailing Address - Fax:
Practice Address - Street 1:12600 SE 38TH ST STE 130
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6105
Practice Address - Country:US
Practice Address - Phone:206-330-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical