Healthcare Provider Details

I. General information

NPI: 1992016026
Provider Name (Legal Business Name): MADHULIKA SARUPRIA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16225 NE 87TH ST
REDMOND WA
98052-3536
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 425-653-4960
  • Fax: 425-653-4961
Mailing address:
  • Phone: 206-901-2000
  • Fax: 206-901-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60495394
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: