Healthcare Provider Details

I. General information

NPI: 1720419716
Provider Name (Legal Business Name): UNIVERSITY OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 UNIVERSITY WAY NE BOX 355915
SEATTLE WA
98195-5915
US

IV. Provider business mailing address

3935 UNIVERSITY WAY NE BOX 355915
SEATTLE WA
98195-5915
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-2782
  • Fax:
Mailing address:
  • Phone: 206-543-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberH-128
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberH-128
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberH-128
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License NumberH-128
License Number StateWA

VIII. Authorized Official

Name: DR. MARSHA MARIE LINEHAN
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 206-543-9886