MEDICARE: MR. BRUCE BARTJA WACHTEL 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	104100000X	Social Worker	LICSW	WA

General Provider Information

NPI Number	:	1891890927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE BARTJA WACHTEL LICSW

Provider Business Mailing Address
First Line	:	4111 STONE WAY N STE A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8052
Country	:	US
Telephone Number	:	206-250-9166
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 FAIRVIEW AVE E STE 205
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3727
Country	:	US
Telephone Number	:	206-250-9166
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/31/2018

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