MEDICARE: MEGAN SMEDSRUD MSW

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	SC60501443	WA

General Provider Information

NPI Number	:	1912389552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN SMEDSRUD MSW

Provider Business Mailing Address
First Line	:	3813 37TH AVE S., APT LOWER
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118
Country	:	US
Telephone Number	:	347-694-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3813 37TH AVE S APT LOWER
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1101
Country	:	US
Telephone Number	:	347-694-9260
Fax Number	:

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

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	06/19/2015

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