Provider Demographics
NPI:1194059741
Name:LEE, KAREN BLIDDAL (MS)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:BLIDDAL
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 112TH AVE NE
Mailing Address - Street 2:SUITE NUMBER 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2943
Mailing Address - Country:US
Mailing Address - Phone:206-282-7030
Mailing Address - Fax:
Practice Address - Street 1:2025 112TH AVE NE
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2943
Practice Address - Country:US
Practice Address - Phone:206-282-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000054671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical