MEDICARE: REBECCA BASKETT

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	104100000X	Social Worker	SC60183702	WA

General Provider Information

NPI Number	:	1366833592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BASKETT

Provider Business Mailing Address
First Line	:	6424 N 9TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98406-2091
Country	:	US
Telephone Number	:	253-565-4484
Fax Number	:	253-565-5823

Provider Business Practice Location Address
First Line	:	1420 S MERIDIAN
Second Line	:	SUITE B
City	:	PUYALLUP
State	:	WA
Zip	:	98371-6914
Country	:	US
Telephone Number	:	253-697-8400
Fax Number	:	253-565-5823

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

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/10/2015

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