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NPI Code Detail

MEDICARE: MS. ERIN KIM MARTIN LISW-S, LICDC

MEDICARE: MS. ERIN KIM MARTIN LISW-S, LICDC
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
1104100000XSocial WorkerS.1200780OH
21041C0700XClinical Social Worker61690853WA
31041C0700XClinical Social WorkerI.1450830OH

General Provider Information

NPI Number : 1720429749
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ERIN KIM MARTIN LISW-S, LICDC
Provider Business Mailing Address
First Line : 307 W COTA ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2265
Country : US
Telephone Number : 360-205-8001
Fax Number :
Provider Business Practice Location Address
First Line : 307 W COTA ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2265
Country : US
Telephone Number : 360-205-8001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2013
Last Update Date : 09/16/2025

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