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NPI Code Detail

MEDICARE: WAKING WISDOM PLLC

MEDICARE: WAKING WISDOM PLLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1740154574
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAKING WISDOM PLLC
Provider Business Mailing Address
First Line : PO BOX 253
Second Line : 3040 78TH AVE SE
City : MERCER ISLAND
State : WA
Zip : 98040-9998
Country : US
Telephone Number : 206-486-4042
Fax Number : 206-558-1391
Provider Business Practice Location Address
First Line : 7109 WOODLAWN AVE NE STE 204
Second Line :
City : SEATTLE
State : WA
Zip : 98115-5434
Country : US
Telephone Number : 206-486-4042
Fax Number : 206-558-1391
Authorized Official
Title or Position : CEO
Name : MR. GREGORY EUGENE WHITING
Credential : LICSW
Telephone Number : 248-470-6040
Provider Enumeration Date : 10/03/2025
Last Update Date : 05/22/2026

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