Provider Demographics
NPI:1174819262
Name:DALY, JASON DEAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DEAN
Last Name:DALY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:DEAN
Other - Last Name:GOADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1101 MADISON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3599
Mailing Address - Country:US
Mailing Address - Phone:206-505-1300
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON ST STE 301
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3599
Practice Address - Country:US
Practice Address - Phone:206-505-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL49101041C0700X
WALW61061942104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical