Provider Demographics
NPI:1093905622
Name:DAVIS, MARTHA LOUISE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:DAVIS
Other - Last Name:TAZIOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:14249 AMBAUM BLVD SW
Mailing Address - Street 2:R
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1421
Mailing Address - Country:US
Mailing Address - Phone:206-431-8559
Mailing Address - Fax:206-444-0406
Practice Address - Street 1:14249 AMBAUM BLVD SW
Practice Address - Street 2:R
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1421
Practice Address - Country:US
Practice Address - Phone:206-431-8559
Practice Address - Fax:206-444-0406
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000049011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical