MEDICARE: MR. JED MARKUS LIN MSW, LICSW

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	LW60139783	WA

General Provider Information

NPI Number	:	1770636177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JED MARKUS LIN MSW, LICSW

Provider Business Mailing Address
First Line	:	1600 E OLIVE ST
Second Line	:	SOUND MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98122-2735
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	9706 4TH AVE NE
Second Line	:	SOUND MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98115-2157
Country	:	US
Telephone Number	:	206-302-2900
Fax Number	:	206-302-2910

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	12/15/2016

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