Healthcare Provider Details

I. General information

NPI: 1578680336
Provider Name (Legal Business Name): JACQUI C. METZGER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 NE 51ST ST
SEATTLE WA
98105-5713
US

IV. Provider business mailing address

2271 NE 51ST ST
SEATTLE WA
98105-5713
US

V. Phone/Fax

Practice location:
  • Phone: 206-522-8553
  • Fax: 206-522-7815
Mailing address:
  • Phone: 206-522-8553
  • Fax: 206-522-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00005841
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: