Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LW60404468 | WA |
N | 1041C0700X | Clinical Social Worker | LW60404468 | WA |
NPI | 1003048182 |
---|---|
Provider Name | Ms. Heidi Griffin Street |
First Address | Seattle, WA 98122-2735 |
Second Address | Seattle, WA 98118-2706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 01/04/2020 |