Provider Demographics
NPI:1114751401
Name:KLEIN, VICTORIA AUDREY (AM, LICSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:AUDREY
Last Name:KLEIN
Suffix:
Gender:F
Credentials:AM, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S JACKSON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2872
Mailing Address - Country:US
Mailing Address - Phone:206-948-7250
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON ST STE 301
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2872
Practice Address - Country:US
Practice Address - Phone:206-948-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW614175561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical