MEDICARE: COSETTE DAWNA RAE LSWAIC, NCTMB, LMP,

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	SC60106047	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1609939891	OTHER	WA	PREMERA

General Provider Information

NPI Number	:	1609939891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COSETTE DAWNA RAE LSWAIC, NCTMB, LMP,

Provider Business Mailing Address
First Line	:	1001 290TH AVE SE
Second Line	:
City	:	FALL CITY
State	:	WA
Zip	:	98024-7403
Country	:	US
Telephone Number	:	425-222-3706
Fax Number	:	888-788-3419

Provider Business Practice Location Address
First Line	:	1001 290TH AVE SE
Second Line	:
City	:	FALL CITY
State	:	WA
Zip	:	98024-7403
Country	:	US
Telephone Number	:	425-222-3706
Fax Number	:	888-788-3419

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	06/25/2025

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