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1982684304

NPI Code Detail

MEDICARE: MRS. MARIAN R SCHULTZ MSW

MEDICARE: MRS. MARIAN R SCHULTZ 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	101YM0800X	Mental Health Counselor	LW00004371	WA
2	101YM0800X	Mental Health Counselor	149.012346	IL
3	1041C0700X	Clinical Social Worker	LW00004371	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2233222	OTHER	IL	BLUE CROSS BLUE SHIELD
3	000010016208	OTHER	ID	REGENCE BCBS

General Provider Information

NPI Number	:	1982684304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIAN R SCHULTZ MSW

Provider Business Mailing Address
First Line	:	1616 CORNWALL AVE STE 205
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4642
Country	:	US
Telephone Number	:	360-676-6177
Fax Number	:	360-671-3754

Provider Business Practice Location Address
First Line	:	6060 PORTAL WAY
Second Line	:
City	:	FERNDALE
State	:	WA
Zip	:	98248-7833
Country	:	US
Telephone Number	:	360-676-6177
Fax Number	:	360-671-3574

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/10/2019

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Directions to “ MRS. MARIAN R SCHULTZ MSW” Practice Location

Language	Start Address	Practice Location

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