| Rebecca M. Fishaut, Msw, Licsw, Pllc | |
|
1417 Nw 54th St Ste 334 Seattle WA 98107-3571 | |
| (425) 954-7473 | |
| (844) 308-5012 |
| Full Name | Rebecca M. Fishaut, Msw, Licsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1417 Nw 54th St Ste 334, Seattle, Washington |
| Authorized Official Name and Position | Rebecca M. Fishaut (THERAPIST/SOLE PROPRIETOR) |
| Authorized Official Contact | 4259547473 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rebecca M. Fishaut, Msw, Licsw, Pllc 1417 Nw 54th St Ste 334 Seattle WA 98107-3571 Ph: (425) 954-7473 | Rebecca M. Fishaut, Msw, Licsw, Pllc 1417 Nw 54th St Ste 334 Seattle WA 98107-3571 Ph: (425) 954-7473 |
| NPI Number | 1821452640 |
|---|---|
| Provider Enumeration Date | 04/07/2016 |
| Last Update Date | 02/16/2022 |
| Certification Date | 02/16/2022 |
| Medicare PECOS PAC ID | 0345548798 |
|---|---|
| Medicare Enrollment ID | O20160418002352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821452640 | NPI | - | NPPES |
| 2074083 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LW60205276 (Washington) | Primary |
| Provider Name | Rebecca M Fishaut |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174815922 PECOS PAC ID: 1951570837 Enrollment ID: I20110810000356 |
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