Basic Information
| Provider Information | |||||||||
| NPI: | 1679995005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOCHANSKI | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | S-123-PCC | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062774902 | ||||||||
| FaxNumber: | 2067642936 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | S-123-PCC | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062774902 | ||||||||
| FaxNumber: | 2067642936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2014 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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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 | 104100000X | SC60424614 | WA | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 11277 | SC | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW-4168 | HI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.