Healthcare Provider Details

I. General information

NPI: 1265269245
Provider Name (Legal Business Name): CHARLOTTE MCINTOSH LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE STE 900
SEATTLE WA
98104-3596
US

IV. Provider business mailing address

901 BOREN AVE STE 900
SEATTLE WA
98104-3596
US

V. Phone/Fax

Practice location:
  • Phone: 425-326-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC70000771
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: