MEDICARE: MELISSA AMBER MANIX 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	020704SW40002165	WA

General Provider Information

NPI Number	:	1366684375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA AMBER MANIX MSW, LICSW

Provider Business Mailing Address
First Line	:	100 W HARRISON ST
Second Line	:	SOUTH TOWER, SUITE 330
City	:	SEATTLE
State	:	WA
Zip	:	98119-4116
Country	:	US
Telephone Number	:	206-283-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W HARRISON ST
Second Line	:	SOUTH TOWER, SUITE 330
City	:	SEATTLE
State	:	WA
Zip	:	98119-4116
Country	:	US
Telephone Number	:	206-283-3000
Fax Number	:

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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