MEDICARE: BRUCE HINSDALE LW

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	LW00005814	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1029HI	OTHER	WA	REGENCE

General Provider Information

NPI Number	:	1568651529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE HINSDALE LW

Provider Business Mailing Address
First Line	:	232 2ND AVE S STE 201
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-5862
Country	:	US
Telephone Number	:	253-859-0300
Fax Number	:	253-859-0745

Provider Business Practice Location Address
First Line	:	232 2ND AVE S STE 201
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-5862
Country	:	US
Telephone Number	:	253-859-0300
Fax Number	:	253-859-0745

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

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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Directions to “ BRUCE HINSDALE LW” Practice Location

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