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NPI Code Detail

MEDICARE: MR. CARL HILTON VANOSDALL LICSW

MEDICARE: MR. CARL HILTON VANOSDALL 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
11041C0700XClinical Social Worker
21041C0700XClinical Social Worker089-0001021VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100068055OTHERVTBC/BS VT
22273134OTHERVTCIGNA
3360324OTHERVTTRICARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710918073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARL HILTON VANOSDALL LICSW
Provider Business Mailing Address
First Line : PO BOX 1003
Second Line :
City : KINGSTON
State : WA
Zip : 98346-1003
Country : US
Telephone Number : 802-272-4037
Fax Number :
Provider Business Practice Location Address
First Line : 564 NE RAVENNA BLVD
Second Line :
City : SEATTLE
State : WA
Zip : 98115-6460
Country : US
Telephone Number : 206-527-2266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 06/06/2022

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