Healthcare Provider Details

I. General information

NPI: 1174819262
Provider Name (Legal Business Name): JASON DEAN DALY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JASON DEAN GOADE MSW, LCSW

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 07/21/2022
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 301
SEATTLE WA
98104-3599
US

IV. Provider business mailing address

1101 MADISON ST STE 301
SEATTLE WA
98104-3599
US

V. Phone/Fax

Practice location:
  • Phone: 206-505-1300
  • Fax:
Mailing address:
  • Phone: 206-505-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW61061942
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4910
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: