Provider Demographics
NPI:1568786515
Name:PRESCOTT, SUSAN GAIL (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 5TH AVE NE STE 215
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7471
Mailing Address - Country:US
Mailing Address - Phone:425-753-0255
Mailing Address - Fax:206-535-8922
Practice Address - Street 1:10212 5TH AVE NE STE 215
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7471
Practice Address - Country:US
Practice Address - Phone:425-753-0255
Practice Address - Fax:206-535-8922
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000076041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040078Medicaid