NPIMap

Organization Active NPI

Kelly Druin Sievertson, Licsw

  • Clinic/Center
  • Edmonds, WA
National Provider Identifier
1285010868
Registry record updated Aug 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
LW60229562 Issued in WA
Legal business name
KELLY DRUIN SIEVERTSON, LICSW
Practice address
316 Main St
Suite B
Edmonds, WA 98020-3197
Phone
(206) 486-0295
NPI assigned
Aug 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly Sievertson, MSW,LICSW
Title
Owner
Phone
(206) 486-0295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X LW60229562 WA Primary

Addresses

Primary practice location

316 Main St
Suite B
Edmonds, WA 98020-3197

Mailing address

316 Main St
Suite B
Edmonds, WA 98020-3197

National Provider Directory

National Provider Directory

Locations

316 Main St
Ste B
Edmonds, WA 98020
Phone (206) 486-0295

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438732800000",
    "number": "1285010868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 MAIN ST",
            "address_2": "SUITE B",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980203197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 MAIN ST",
            "address_2": "SUITE B",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980203197",
            "telephone_number": "206-486-0295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY DRUIN SIEVERTSON, LICSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-05",
        "last_updated": "2015-08-05",
        "status": "A",
        "authorized_official_last_name": "SIEVERTSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-486-0295",
        "authorized_official_credential": "MSW,LICSW"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "LW60229562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.