=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689152183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA LEOTA SPAUDE LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2018
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1455 NW LEARY WAY STE 400
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-941-7645
-----------------------------------------------------
Fax | 929-596-7897
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4750 E UNION HILLS DR APT 2120
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-3383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-562-1054
-----------------------------------------------------
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 | LW61237737
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------