MEDICARE: KARIAH C PHILLIPS MSW, 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
1	1041C0700X	Clinical Social Worker	LW60200313	WA

General Provider Information

NPI Number	:	1316128523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIAH C PHILLIPS MSW, LICSW

Provider Business Mailing Address
First Line	:	1033 REGENTS BLVD
Second Line	:	STE 101
City	:	FIRCREST
State	:	WA
Zip	:	98466-6089
Country	:	US
Telephone Number	:	253-238-6554
Fax Number	:	253-590-0821

Provider Business Practice Location Address
First Line	:	1033 REGENTS BLVD
Second Line	:	STE 101
City	:	FIRCREST
State	:	WA
Zip	:	98466-6089
Country	:	US
Telephone Number	:	253-238-6554
Fax Number	:	253-590-0821

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	10/17/2018

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