Individual provider Active NPI

Jeffrey Allen Kiilsgaard, LCSW, LICSW, ACSW

  • Social Worker
  • Seattle, WA
National Provider Identifier
1881074904
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
10839 Issued in OR
Practice address
1455 NW Leary Way Ste 400
Seattle, WA 98107-5138
Phone
(253) 370-8980
Fax
(503) 966-0849
NPI assigned
Jun 3, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 10839 OR Primary

Addresses

Primary practice location

1455 NW Leary Way Ste 400
Seattle, WA 98107-5138

Mailing address

10260 SW Greenburg Rd FL 4
Portland, OR 97223-5500
Phone (253) 368-3255

Other practice location 1

4800 S MacAdam Ave Ste 110
Portland, OR 97239-3929
Phone (253) 368-3255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230628003404 WA Practitioner - Clinical Social Worker 9335508043 Reassigns benefits to 1 organization
Practice locations: Seattle, WA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10839ORMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Humanistic Therapy NW Counselor CurrentSince Oct 18, 2024 Accepting new patients

Locations

4800 S Macadam Ave
Ste 110
Portland, OR 97239
Phone (253) 368-3255

1455 NW Leary Way
Ste 400
Seattle, WA 98107
Phone (206) 202-8506

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1881074904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10260 SW GREENBURG RD FL 4",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972235500",
            "telephone_number": "253-368-3255",
            "fax_number": "503-966-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 NW LEARY WAY STE 400",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981075138",
            "telephone_number": "253-370-8980",
            "fax_number": "503-966-0849"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 S MacAdam Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393929",
            "country_code": "US",
            "telephone_number": "253-368-3255",
            "fax_number": "503-966-0849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIILSGAARD",
        "first_name": "JEFFREY",
        "middle_name": "ALLEN",
        "credential": "LCSW, LICSW, ACSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-03",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "10839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.