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NPI Code Detail

MEDICARE: DR. SHATASHA LENISE COLE EDD, LICSW

MEDICARE: DR. SHATASHA LENISE COLE EDD, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker091915-1NY
21041C0700XClinical Social WorkerLW60628629WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LW60628629OTHERWALICSW
2091915-1OTHERNYLMSW

General Provider Information

NPI Number : 1093191983
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHATASHA LENISE COLE EDD, LICSW
Provider Business Mailing Address
First Line : 901 BOREN AVE STE 1300
Second Line :
City : SEATTLE
State : WA
Zip : 98104-3509
Country : US
Telephone Number : 253-336-6468
Fax Number : 844-383-1077
Provider Business Practice Location Address
First Line : 901 BOREN AVE STE 1300
Second Line :
City : SEATTLE
State : WA
Zip : 98104-3509
Country : US
Telephone Number : 253-336-6468
Fax Number : 844-383-1077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2015
Last Update Date : 07/21/2022

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