MEDICARE: BARBARA GROTE PHD

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	103T00000X	Psychologist	PY00003587	WA

General Provider Information

NPI Number	:	1225186802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA GROTE PHD

Provider Business Mailing Address
First Line	:	444 26TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-4729
Country	:	US
Telephone Number	:	206-330-6175
Fax Number	:	206-860-2829

Provider Business Practice Location Address
First Line	:	1001 BROADWAY
Second Line	:	SUITE 313
City	:	SEATTLE
State	:	WA
Zip	:	98122-4397
Country	:	US
Telephone Number	:	206-860-0860
Fax Number	:	206-860-2829

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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