Provider Demographics
NPI:1811070840
Name:WYOME, KAREN DOROTHY (MSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DOROTHY
Last Name:WYOME
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DOROTHY
Other - Last Name:PEDTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:13610 GREENWOOD AVE N APT C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7371
Mailing Address - Country:US
Mailing Address - Phone:206-850-1270
Mailing Address - Fax:
Practice Address - Street 1:13610 GREENWOOD AVE N APT C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7371
Practice Address - Country:US
Practice Address - Phone:206-850-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW217541041C0700X
COCSW099286021041C0700X
WALW000040911041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038120Medicaid
IL1223OtherLAST FOUR OF SSN