=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417183799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SWAN TSO MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2009
-----------------------------------------------------
Last Update Date | 04/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14040 NE 8TH STREET STE 204
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-849-9002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14040 NE 8TH ST STE 204
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98007-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-849-9002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW 60016393
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------