Healthcare Provider Details

I. General information

NPI: 1417464769
Provider Name (Legal Business Name): TONI HUGHES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10634 E RIVERSIDE DR STE 130
BOTHELL WA
98011-3758
US

IV. Provider business mailing address

17110 NE 45TH ST APT 28
REDMOND WA
98052-5633
US

V. Phone/Fax

Practice location:
  • Phone: 910-599-1764
  • Fax:
Mailing address:
  • Phone: 910-599-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61230167
License Number StateWA

VII. Legacy identifiers

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

# 1
Identifier2117983
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: