MEDICARE: MS. JOAN PATRICE WILLEMAIN LICSW,CMHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW00006182	WA

General Provider Information

NPI Number	:	1083964670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN PATRICE WILLEMAIN LICSW,CMHS

Provider Business Mailing Address
First Line	:	9226 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2908
Country	:	US
Telephone Number	:	206-466-8225
Fax Number	:

Provider Business Practice Location Address
First Line	:	9226 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2908
Country	:	US
Telephone Number	:	206-466-8225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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