Healthcare Provider Details

I. General information

NPI: 1699163584
Provider Name (Legal Business Name): PASHA GRANT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22722 29TH DR SE STE 100
BOTHELL WA
98021-4420
US

IV. Provider business mailing address

2722 COLBY AVE STE 507
EVERETT WA
98201-3533
US

V. Phone/Fax

Practice location:
  • Phone: 425-312-2512
  • Fax:
Mailing address:
  • Phone: 520-991-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60639747
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: