MEDICARE: MS. TRACY KATHERINE WATSON LICSW

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	LW00007798	WA

General Provider Information

NPI Number	:	1124395728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY KATHERINE WATSON LICSW

Provider Business Mailing Address
First Line	:	3462 40TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3420
Country	:	US
Telephone Number	:	206-707-2906
Fax Number	:

Provider Business Practice Location Address
First Line	:	3462 40TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3420
Country	:	US
Telephone Number	:	206-707-2906
Fax Number	:

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

Provider Enumeration Date	:	11/27/2011
Last Update Date	:	11/27/2011

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