Active NPI
Nicole Kudelka
- Mental Health Counselor
- Olympia, WA
National Provider Identifier
1609608405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MC70048542
- Practice address
- 711 State Ave NE
Olympia, WA 98506-3984 - Phone
- (360) 943-0780
- NPI assigned
- Aug 19, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC70048542 | WA | Primary |
Addresses
Primary practice location
711 State Ave NE
Olympia, WA 98506-3984
Mailing address
711 State Ave NE
Olympia, WA 98506-3984
Phone (360) 943-0780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC70048542 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759449600000",
"number": "1609608405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 STATE AVE NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985063984",
"telephone_number": "360-943-0780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 STATE AVE NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985063984",
"telephone_number": "360-943-0780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUDELKA",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-19",
"last_updated": "2025-10-03",
"certification_date": "2025-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MC70048542",
"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 Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.