Healthcare Provider Details

I. General information

NPI: 1134371016
Provider Name (Legal Business Name): ALLISON MAY TERBIETEN BA, MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH AVE
SEATTLE WA
98122-5699
US

IV. Provider business mailing address

550 16TH AVE
SEATTLE WA
98122-5699
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-7070
  • Fax: 206-320-4568
Mailing address:
  • Phone: 206-320-7070
  • Fax: 206-320-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 60348902
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: