Healthcare Provider Details

I. General information

NPI: 1174904726
Provider Name (Legal Business Name): JAMIE ELZEA MSW, MPH, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 238TH ST SE SUITE L
BOTHELL WA
98021-4309
US

IV. Provider business mailing address

14618 47TH PL W
LYNNWOOD WA
98087-1859
US

V. Phone/Fax

Practice location:
  • Phone: 206-552-1247
  • Fax:
Mailing address:
  • Phone: 206-552-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60403580
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: