MEDICARE: MS. LYNN M VIGO MSW, 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	LW 60158442	WA
2	104100000X	Social Worker	LW 60158442	WA

General Provider Information

NPI Number	:	1306140694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNN M VIGO MSW, LICSW

Provider Business Mailing Address
First Line	:	2517 EASTLAKE AVE E
Second Line	:	SUITE 102
City	:	SEATTLE
State	:	WA
Zip	:	98102-3278
Country	:	US
Telephone Number	:	425-780-9584
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 EASTLAKE AVE E
Second Line	:	SUITE 102
City	:	SEATTLE
State	:	WA
Zip	:	98102-3278
Country	:	US
Telephone Number	:	425-780-9584
Fax Number	:

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

Provider Enumeration Date	:	01/01/2011
Last Update Date	:	09/06/2011

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