Provider Demographics
NPI:1902312309
Name:LEE, JAMIE SHARON HEEGYUNG KIM (LICSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SHARON HEEGYUNG KIM
Last Name:LEE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:SHARON HEEGYUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-583-6433
Mailing Address - Fax:
Practice Address - Street 1:925 SENECA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2742
Practice Address - Country:US
Practice Address - Phone:206-583-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VALW603269161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical