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NPI Code Detail

MEDICARE: GLADYS NAHUM RODRIGUEZ LSWAIC

MEDICARE: GLADYS NAHUM RODRIGUEZ 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
11041C0700XClinical Social WorkerSC60967688WA

General Provider Information

NPI Number : 1740827963
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLADYS NAHUM RODRIGUEZ LSWAIC
Provider Business Mailing Address
First Line : 11509 85TH AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98178-3903
Country : US
Telephone Number : 509-998-7438
Fax Number :
Provider Business Practice Location Address
First Line : 3715 S HUDSON ST STE 102
Second Line :
City : SEATTLE
State : WA
Zip : 98118-2171
Country : US
Telephone Number : 206-350-5708
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2019
Last Update Date : 12/06/2019

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