MEDICARE: AZRA GRUDIC CONSULTING AND COUNSELING

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	251S00000X	Community/Behavioral Health Agency	SA 60148730	WA

General Provider Information

NPI Number	:	1427507722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZRA GRUDIC CONSULTING AND COUNSELING

Provider Business Mailing Address
First Line	:	3617 186TH PL NE # 4A
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7928
Country	:	US
Telephone Number	:	425-418-9026
Fax Number	:

Provider Business Practice Location Address
First Line	:	3617 186TH PL NE # 4A
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7928
Country	:	US
Telephone Number	:	425-418-9026
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	AZRA GRUDIC
Credential	:	MSW
Telephone Number	:	425-418-9026

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	09/27/2016

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