Basic Information
| Provider Information | |||||||||
| NPI: | 1962954891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GROUP HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20210 84TH PL W | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980266604 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9800 4TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981152152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063021200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2016 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RICHARD-WEBBER | ||||||||
| AuthorizedOfficialFirstName: | JENIKA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | INNOVATION SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 5038030899 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60463246 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.