Basic Information
| Provider Information | |||||||||
| NPI: | 1568132579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MELANIE | ||||||||
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| Credential: | MSW LSWAIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4055 S 128TH ST | ||||||||
| Address2: | |||||||||
| City: | TUKWILA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981682573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303105085 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 SW HOLDEN ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069337000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2021 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SC60997990 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.