MEDICARE: ETHEL G NELSON-KING LSWAIC

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	104100000X	Social Worker	SC6144705	WA

General Provider Information

NPI Number	:	1689188641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHEL G NELSON-KING LSWAIC

Provider Business Mailing Address
First Line	:	16322 KENDONS WAY LN
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-4897
Country	:	US
Telephone Number	:	678-818-8633
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 N OLYMPIC AVE STE 234
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1322
Country	:	US
Telephone Number	:	360-572-8655
Fax Number	:

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

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	07/17/2025

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