Healthcare Provider Details

I. General information

NPI: 1629668223
Provider Name (Legal Business Name): MADELYN GATES ROBERTSON MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELYN COVEY

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 S 7TH ST
TACOMA WA
98405-2506
US

IV. Provider business mailing address

3121 S 7TH ST
TACOMA WA
98405-2506
US

V. Phone/Fax

Practice location:
  • Phone: 253-302-4639
  • Fax:
Mailing address:
  • Phone: 253-302-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61556021
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: