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General NPI Number Information
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NPI Number | 1104175868
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Entity Type | Individual
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Provider Name | COURTNEY ELIZABETH CAMPBELL M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2012
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 275 BRONSON WAY NE
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City | RENTON
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State | WA
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Zip | 98056-4030
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Country | US
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Telephone | 425-235-2800
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Fax | 425-235-2815
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Provider Business Mailing Address
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Address Line | 275 BRONSON WAY NE
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City | RENTON
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State | WA
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Zip | 98056-4030
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Country | US
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Telephone | 425-235-2800
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Fax | 425-235-2815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60243106
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License Number State | WA
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