MEDICARE: MRS. MARY ANN HENDRICKS SKENDER MSW, LSWAIC, CDPT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO60269858	WA
2	104100000X	Social Worker	SC60269721	WA
3	1041C0700X	Clinical Social Worker	SC60269721	WA

General Provider Information

NPI Number	:	1356684252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANN HENDRICKS SKENDER MSW, LSWAIC, CDPT

Provider Business Mailing Address
First Line	:	1600 E OLIVE ST
Second Line	:	SOUND MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98122-2735
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	400 YESLER WAY
Second Line	:	SOUND MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98104-2683
Country	:	US
Telephone Number	:	206-669-0833
Fax Number	:	206-726-5742

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

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	03/29/2013

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