MEDICARE: LYLA ROSS 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	LW60034699	WA

General Provider Information

NPI Number	:	1972818169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYLA ROSS LICSW

Provider Business Mailing Address
First Line	:	3876 BRIDGE WAY N
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98103-7951
Country	:	US
Telephone Number	:	206-707-9611
Fax Number	:

Provider Business Practice Location Address
First Line	:	3876 BRIDGE WAY N
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98103-7951
Country	:	US
Telephone Number	:	206-707-9611
Fax Number	:

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

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/11/2010

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