MEDICARE: MS. LYN SPLITGABER KRATZ M.S.W.

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	LW00006166	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LW00006166	OTHER	WA	LICSW

General Provider Information

NPI Number	:	1639113715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYN SPLITGABER KRATZ M.S.W.

Provider Business Mailing Address
First Line	:	5400 CALIFORNIA AVE SW
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98136-1501
Country	:	US
Telephone Number	:	206-935-7407
Fax Number	:	206-932-0401

Provider Business Practice Location Address
First Line	:	5400 CALIFORNIA AVE SW
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98136-1501
Country	:	US
Telephone Number	:	206-935-7407
Fax Number	:	206-932-0401

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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