Provider Demographics
NPI:1821452640
Name:REBECCA M. FISHAUT, MSW, LICSW, PLLC
Entity Type:Organization
Organization Name:REBECCA M. FISHAUT, MSW, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHAUT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:425-954-7473
Mailing Address - Street 1:1417 NW 54TH ST STE 334
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3571
Mailing Address - Country:US
Mailing Address - Phone:425-954-7473
Mailing Address - Fax:844-308-5012
Practice Address - Street 1:1417 NW 54TH ST STE 334
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3571
Practice Address - Country:US
Practice Address - Phone:425-954-7473
Practice Address - Fax:844-308-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602052761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2074083Medicaid