MEDICARE: MS. NICOLE PODELL LCSW

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	L7972	OR
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1041C0700X	Clinical Social Worker	L7972	WA

General Provider Information

NPI Number	:	1447648829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE PODELL LCSW

Provider Business Mailing Address
First Line	:	2702 17TH AVE S # A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-5112
Country	:	US
Telephone Number	:	541-632-3238
Fax Number	:	313-831-2608

Provider Business Practice Location Address
First Line	:	2702 17TH AVE S # A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-5112
Country	:	US
Telephone Number	:	541-632-3238
Fax Number	:	313-831-2608

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

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	03/21/2023

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