Individual
ELLA IDIL INDRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
720 N 35TH ST, SEATTLE, WA 98103-8816
(206) 351-3831
Mailing address
8302 26TH AVE NW, SEATTLE, WA 98117-4447
(206) 351-3831
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW00008708
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LW00008708
WA STATE
WA
Enumeration date
05/11/2013
Last updated
05/11/2013
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