Provider Demographics
NPI:1750823662
Name:SEATTLE SOCIAL WORK AND COUNSELING
Entity type:Organization
Organization Name:SEATTLE SOCIAL WORK AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-598-3713
Mailing Address - Street 1:7414 S 128TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4346
Mailing Address - Country:US
Mailing Address - Phone:858-598-3713
Mailing Address - Fax:
Practice Address - Street 1:1812 E MADISON ST
Practice Address - Street 2:#202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2843
Practice Address - Country:US
Practice Address - Phone:858-598-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60543263251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management