Provider Demographics
NPI:1720124266
Name:KAKUTANI, KIYOKO (MSW LICSW)
Entity type:Individual
Prefix:
First Name:KIYOKO
Middle Name:
Last Name:KAKUTANI
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 5TH AVE NE SUITE 150
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-418-0600
Mailing Address - Fax:206-418-0600
Practice Address - Street 1:10212 5TH AVE NE STE 150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7473
Practice Address - Country:US
Practice Address - Phone:206-418-0600
Practice Address - Fax:206-418-0600
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005999104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker