Healthcare Provider Details

I. General information

NPI: 1851401657
Provider Name (Legal Business Name): MERIDETH ANN BURNESS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MERIDETH ANN LOONEY MSW

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4744 41ST AVE SW SUITE 317
SEATTLE WA
98116
US

IV. Provider business mailing address

4744 41ST AVE SW SUITE 317
SEATTLE WA
98116
US

V. Phone/Fax

Practice location:
  • Phone: 206-389-1265
  • Fax: 206-938-1234
Mailing address:
  • Phone: 206-389-1265
  • Fax: 206-938-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW4534
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: