MEDICARE: MS. HEATHER LYNN MCLELLAN SWAIC

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	104100000X	Social Worker	SC61146312	WA

General Provider Information

NPI Number	:	1194310300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER LYNN MCLELLAN SWAIC

Provider Business Mailing Address
First Line	:	12319 116TH STREET CT NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-5760
Country	:	US
Telephone Number	:	253-228-6390
Fax Number	:

Provider Business Practice Location Address
First Line	:	7282 STINSON AVE STE B
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-4930
Country	:	US
Telephone Number	:	253-858-5846
Fax Number	:

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

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	03/09/2021

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