Provider Demographics
NPI:1679191761
Name:DAVIS, SARAH LOUISE GOSSMAN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE GOSSMAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LOUISE
Other - Last Name:GOSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3023 14TH AVE W APT 402
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2065
Mailing Address - Country:US
Mailing Address - Phone:425-223-7573
Mailing Address - Fax:
Practice Address - Street 1:2100 WESTLAKE AVE N STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5802
Practice Address - Country:US
Practice Address - Phone:206-858-1177
Practice Address - Fax:206-913-2369
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC609382631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical