Healthcare Provider Details

I. General information

NPI: 1073422770
Provider Name (Legal Business Name): MADISON ANNE MARIE CLAY LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 BALLARD AVE NW
SEATTLE WA
98107-4366
US

IV. Provider business mailing address

5306 BALLARD AVE NW
SEATTLE WA
98107-4366
US

V. Phone/Fax

Practice location:
  • Phone: 206-403-1148
  • Fax: 206-800-1091
Mailing address:
  • Phone: 206-403-1148
  • Fax: 206-800-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70135606
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: