1578829693 NPI number — MS. MARSHA MARIE MEYERS L.I.C.S.W.

Table of content: MS. MARSHA MARIE MEYERS L.I.C.S.W. (NPI 1578829693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578829693 NPI number — MS. MARSHA MARIE MEYERS L.I.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYERS
Provider First Name:
MARSHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.I.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RASMUSSEN
Provider Other First Name:
MARSHA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578829693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 114TH AVE SE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-6950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-462-7909
Provider Business Mailing Address Fax Number:
425-643-8903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 114TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-6950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-462-7909
Provider Business Practice Location Address Fax Number:
425-643-8903
Provider Enumeration Date:
04/03/2012

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:  SW00004491 , 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)





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