| |
3924 204th St Sw Ste. 111 Lynnwood WA 98036-9368 | |
(206) 522-5378 | |
(206) 527-3375 |
Full Name | |
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Speciality | Social Worker - Clinical |
Location | 3924 204th St Sw, Lynnwood, Washington |
Authorized Official Name and Position | Robert Patterson Lyle (PRESIDENT) |
Authorized Official Contact | 2065274395 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3924 204th St Sw Ste. 111 Lynnwood WA 98036-9368 Ph: (206) 522-5378 | 3924 204th St Sw Ste. 111 Lynnwood WA 98036-9368 Ph: (206) 522-5378 |
NPI Number | 1902817125 |
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Provider Enumeration Date | 08/11/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902817125 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | LW00005375 (Washington) | Primary |
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