Provider Demographics
NPI:1770270563
Name:MARKULEC, KENNEDY (LMHCA)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:MARKULEC
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:KENNEDY
Other - Middle Name:
Other - Last Name:POORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHCA
Mailing Address - Street 1:4208 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 NE 100TH ST STE 125
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8010
Practice Address - Country:US
Practice Address - Phone:206-636-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61360889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health