Active NPI
Kaden Sullivan, MSW, LSWAIC
- Clinical Social Worker
- Olympia, WA
National Provider Identifier
1356165146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SC61448604
- Practice address
- 1220 4TH Ave E
Olympia, WA 98506-4212 - Phone
- (360) 320-6876
- NPI assigned
- Nov 8, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SC61448604 | WA | Primary |
Addresses
Primary practice location
1220 4TH Ave E
Olympia, WA 98506-4212
Mailing address
PO Box 257
PMB 10719
Olympia, WA 98507-0257
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 30, 2026 through Mar 30, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC61448604 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735344000000",
"number": "1356165146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 257",
"address_2": "PMB 10719",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985070257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 4TH AVE E",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985064212",
"telephone_number": "360-320-6876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KADEN",
"credential": "MSW, LSWAIC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-11-08",
"last_updated": "2024-12-28",
"certification_date": "2024-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "SC61448604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2024; 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.