Healthcare Provider Details

I. General information

NPI: 1477208593
Provider Name (Legal Business Name): CYNTHIA ONETTA SESSOMS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 NE SUNSET BLVD UNIT C2
RENTON WA
98059-4028
US

IV. Provider business mailing address

4300 NE SUNSET BLVD UNIT C2
RENTON WA
98059-4028
US

V. Phone/Fax

Practice location:
  • Phone: 443-281-9532
  • Fax:
Mailing address:
  • Phone: 443-281-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61140745
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: