Healthcare Provider Details

I. General information

NPI: 1598245557
Provider Name (Legal Business Name): OLIVIA BRONSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

6851 AITKEN DR
OAKLAND CA
94611-1511
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-4100
  • Fax:
Mailing address:
  • Phone: 415-847-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: