Andrea Lee Dieleman, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60874880 Issued in WA

Practice address

9800 4TH Ave NE
Seattle, WA 98115-2152

Phone

(206) 302-1200

NPI assigned

Sep 26, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2023 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healing Roots Therapy Group

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1437931532
  NPD Authorized official
• Sola Counseling LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1043912181
  NPD Authorized official

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

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1326523325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9800 4TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981152158",
            "telephone_number": "206-302-1200",
            "fax_number": "206-302-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 4TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981152152",
            "telephone_number": "206-302-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIELEMAN",
        "first_name": "ANDREA",
        "middle_name": "LEE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-26",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149018068",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60874880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICSW",
            "identifier": "LW60874880",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED CLINICAL SOCIAL WORKER",
            "identifier": "149018068",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9800 4th Ave NE",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981152152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Delfred Laurie Chris Diehl, M.D., FRCSC
• Megan Gabrielle Diehl, RN, BSN
• Heather Diehr
• Douglas S Diekema
• Susan M. Diekema, OT
• Katherine Walukevich Dienst, PHD
• Justin Diep
• Kimkhanh Thi Diep
• Steven Tien Diep, MD
• Jan Diepenheim, D.D.S.

• Clinical Social Worker in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.