Healthcare Provider Details

I. General information

NPI: 1134414857
Provider Name (Legal Business Name): TALCOTT BROADHEAD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 216TH ST SW STE 100
MOUNTLAKE TERRACE WA
98043-2089
US

IV. Provider business mailing address

100 N HOWARD ST
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 425-678-6463
  • Fax:
Mailing address:
  • Phone: 360-200-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSA60179002
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC61072299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: