MEDICARE: SARAH LOUISE GOSSMAN DAVIS

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	SC60938263	WA

General Provider Information

NPI Number	:	1679191761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LOUISE GOSSMAN DAVIS

Provider Business Mailing Address
First Line	:	3023 14TH AVE W APT 402
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-2065
Country	:	US
Telephone Number	:	425-223-7573
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WESTLAKE AVE N STE 201
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5802
Country	:	US
Telephone Number	:	206-858-1177
Fax Number	:	206-913-2369

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

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	07/06/2020

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