Healthcare Provider Details

I. General information

NPI: 1245919877
Provider Name (Legal Business Name): GRACE EVELYN MARTIN LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SAND POINT WAY NE
SEATTLE WA
98115-7869
US

IV. Provider business mailing address

12334 31ST AVE NE APT 308
SEATTLE WA
98125-5581
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2164
  • Fax:
Mailing address:
  • Phone: 925-550-7382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWI.LW.70041309
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: