Healthcare Provider Details

I. General information

NPI: 1699711184
Provider Name (Legal Business Name): MARY ANN RIGGS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SPRING ST
FRIDAY HARBOR WA
98250-8057
US

IV. Provider business mailing address

PO BOX 247
FRIDAY HARBOR WA
98250-0247
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-2669
  • Fax: 360-378-5669
Mailing address:
  • Phone: 360-378-2669
  • Fax: 360-378-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00005476
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: