MEDICARE: WITNESSED HEALING, PLLC

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

General Provider Information

NPI Number	:	1164183950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITNESSED HEALING, PLLC

Provider Business Mailing Address
First Line	:	127 AVENUE A STE 203
Second Line	:
City	:	SNOHOMISH
State	:	WA
Zip	:	98290-2977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4423 S 3RD AVE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-2515
Country	:	US
Telephone Number	:	425-610-9734
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN COLLINS
Credential	:	LICSW
Telephone Number	:	425-610-9734

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	03/10/2023

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