Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | LW00005246 | WA |
N | 225700000X | Massage Therapist | MA00000248 | WA |
NPI | 1003979642 |
---|---|
Provider Name | Ms. Carol Riley |
First Address | Seattle, WA 98103-6955 |
Second Address | Seattle, WA 98103-6955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |