Provider Demographics
NPI:1326676255
Name:WASHINGTON, FRED (MSW)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 QUAIL CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-5635
Mailing Address - Country:US
Mailing Address - Phone:785-331-5991
Mailing Address - Fax:
Practice Address - Street 1:500 QUAIL CREEK AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5635
Practice Address - Country:US
Practice Address - Phone:785-331-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010795721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical