Healthcare Provider Details

I. General information

NPI: 1033291588
Provider Name (Legal Business Name): MICHELLE LEIGH UPHAM M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY SOCIAL WORK SERVICES
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY SOCIAL WORK SERVICES
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 800-329-8387
  • Fax: 206-764-2514
Mailing address:
  • Phone: 800-329-8387
  • Fax: 206-764-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: