MEDICARE: CHRISTOPHER T PARKS LSWAIC

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	LW61661893	WA

General Provider Information

NPI Number	:	1295441525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER T PARKS LSWAIC

Provider Business Mailing Address
First Line	:	1650 S TOPAZ WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-4474
Country	:	US
Telephone Number	:	208-605-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 N NORTHGATE WAY STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-9018
Country	:	US
Telephone Number	:	425-502-9945
Fax Number	:

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

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/22/2026

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