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NPI Code Detail

MEDICARE: TALCOTT BROADHEAD MSW

MEDICARE: TALCOTT BROADHEAD MSW
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 WorkerSA60179002WA
21041C0700XClinical Social WorkerSWIA.SC61072299WA

General Provider Information

NPI Number : 1134414857
Entity Type Code : Individual
Provider Name (Legal Business Name) : TALCOTT BROADHEAD MSW
Provider Business Mailing Address
First Line : 100 N HOWARD ST
Second Line :
City : SPOKANE
State : WA
Zip : 99201-0508
Country : US
Telephone Number : 360-200-8411
Fax Number :
Provider Business Practice Location Address
First Line : 6505 216TH ST SW STE 100
Second Line :
City : MOUNTLAKE TERRACE
State : WA
Zip : 98043-2089
Country : US
Telephone Number : 425-678-6463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2011
Last Update Date : 12/15/2025

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Directions to “ TALCOTT BROADHEAD MSW” Practice Location

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