Healthcare Provider Details

I. General information

NPI: 1699518662
Provider Name (Legal Business Name): MORGAN MARY BEAZLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 214TH ST SE STE 101
BOTHELL WA
98021-4412
US

IV. Provider business mailing address

12645 NE 140TH ST
KIRKLAND WA
98034-1523
US

V. Phone/Fax

Practice location:
  • Phone: 425-488-4988
  • Fax:
Mailing address:
  • Phone: 415-233-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61454493
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: