MEDICARE: MRS. INDA DRAKE 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
1	1041C0700X	Clinical Social Worker	LW00004181	WA

General Provider Information

NPI Number	:	1144369471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. INDA DRAKE MSW

Provider Business Mailing Address
First Line	:	1127 10TH AVE E STE 4
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4377
Country	:	US
Telephone Number	:	206-325-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 10TH AVE E STE 4
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4377
Country	:	US
Telephone Number	:	206-325-9401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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