MEDICARE: ANNA CHRISTINE MCCONNELL 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker	LW61165443	WA

General Provider Information

NPI Number	:	1457600173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CHRISTINE MCCONNELL LICSW

Provider Business Mailing Address
First Line	:	4511 DENSMORE AVE N STE G
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6783
Country	:	US
Telephone Number	:	206-580-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 DENSMORE AVE N STE G
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6783
Country	:	US
Telephone Number	:	206-580-3080
Fax Number	:

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

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	04/08/2022

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