Basic Information
| Provider Information | |||||||||
| NPI: | 1366813230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTAMA KULAS | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3835 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981243835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065483114 | ||||||||
| FaxNumber: | 2067626355 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 SW THISTLE ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069381360 | ||||||||
| FaxNumber: | 2069356056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2015 | ||||||||
| LastUpdateDate: | 03/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60590581 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.