Healthcare Provider Details

I. General information

NPI: 1912359878
Provider Name (Legal Business Name): JESSICA KING TREMAGLIO LICSW, IMH-E III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANAKI TREMAGLIO LICSW, IMH-E III

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 36TH ST STE 312
SEATTLE WA
98103-8698
US

IV. Provider business mailing address

600 N 36TH ST STE 312
SEATTLE WA
98103-8698
US

V. Phone/Fax

Practice location:
  • Phone: 206-741-0150
  • Fax:
Mailing address:
  • Phone: 206-741-0150
  • Fax: 206-933-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60933756
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: