1093040040 NPI number — JUDITH M HARRIS MSW

Table of content: JUDITH M HARRIS MSW (NPI 1093040040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093040040 NPI number — JUDITH M HARRIS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
JUDITH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093040040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 ROCKEFELLER
Provider Second Line Business Mailing Address:
SNOHOMISH COUNTY HUMAN SERVICES
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-4046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-388-7214
Provider Business Mailing Address Fax Number:
425-388-7216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 ROCKEFELLER AVE
Provider Second Line Business Practice Location Address:
SNOHOMISH COUNTY HUMAN SERVICES
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-388-7214
Provider Business Practice Location Address Fax Number:
425-388-7216
Provider Enumeration Date:
10/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW00004908 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)