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General NPI Number Information
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NPI Number | 1518108109
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Entity Type | Individual
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Provider Name | CHRISTINE LEANNE CERVENKA MSW
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Gender | Female
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 325 9TH AVE BOX 359930
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City | SEATTLE
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State | WA
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Zip | 98104-2499
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Country | US
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Telephone | 206-744-5144
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Fax | 206-744-5109
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Provider Business Mailing Address
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Address Line | BOX 359930 325 9TH AVE
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City | SEATTLE
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State | WA
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Zip | 98104-2499
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Country | US
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Telephone | 206-744-5144
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Fax | 206-744-5109
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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