Provider Demographics
NPI:1417013889
Name:BALCH SPEIGEL, MARY ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY ANNE
Middle Name:
Last Name:BALCH SPEIGEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:MARY ANNE
Other - Middle Name:
Other - Last Name:BALCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:5100 S DAWSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2100
Mailing Address - Country:US
Mailing Address - Phone:206-853-6128
Mailing Address - Fax:866-515-6840
Practice Address - Street 1:5100 S DAWSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2100
Practice Address - Country:US
Practice Address - Phone:206-853-6128
Practice Address - Fax:866-515-6840
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000045121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical