Provider Demographics
NPI:1073863551
Name:WYSE, REBEKAH E (LICSW)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:E
Last Name:WYSE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:REBEKAH
Other - Middle Name:E
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:743 N 100TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9305
Mailing Address - Country:US
Mailing Address - Phone:206-771-1589
Mailing Address - Fax:
Practice Address - Street 1:743 N 100TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9305
Practice Address - Country:US
Practice Address - Phone:206-771-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60298475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker