MEDICARE: JULIE MCGOWAN 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	101YM0800X	Mental Health Counselor	SC60910821	WA

General Provider Information

NPI Number	:	1902407745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MCGOWAN LSWAIC

Provider Business Mailing Address
First Line	:	9222 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2908
Country	:	US
Telephone Number	:	901-652-3343
Fax Number	:

Provider Business Practice Location Address
First Line	:	9222 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2908
Country	:	US
Telephone Number	:	901-652-3343
Fax Number	:

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

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	11/06/2020

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