Active NPI
Grace Claire Mathieson
- Clinical Social Worker
- Marysville, WA
National Provider Identifier
1457946196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW61165345
- Practice address
- 11603 State Ave Ste G
Marysville, WA 98271-8465 - Phone
- (425) 316-5062
- Fax
- (425) 259-8600
- NPI assigned
- Mar 4, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | SC60754947 | WA | |
| Clinical Social Worker | 1041C0700X | LW61165345 | WA | Primary |
Addresses
Primary practice location
11603 State Ave Ste G
Marysville, WA 98271-8465
Mailing address
PO Box 3360
Portland, OR 97208-3360
Phone (425) 316-5062
Other practice location 1
12800 Bothell Everett Hwy
Everett, WA 98208-6642
Phone (425) 316-5062
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | gmathieson1559542@wm.providencedirect.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LW61165345 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636156800000",
"number": "1457946196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3360",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083360",
"telephone_number": "425-316-5062",
"fax_number": "425-259-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11603 STATE AVE STE G",
"city": "MARYSVILLE",
"state": "WA",
"postal_code": "982718465",
"telephone_number": "425-316-5062",
"fax_number": "425-259-8600"
}
],
"practiceLocations": [
{
"address_1": "12800 Bothell Everett Hwy",
"address_purpose": "LOCATION",
"city": "Everett",
"state": "WA",
"postal_code": "982086642",
"country_code": "US",
"telephone_number": "425-316-5062",
"fax_number": "425-259-8600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MATHIESON",
"first_name": "GRACE",
"middle_name": "CLAIRE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-04",
"last_updated": "2021-11-06",
"certification_date": "2021-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "SC60754947",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW61165345",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "gmathieson1559542@wm.providencedirect.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "12800 Bothell Everett Hwy",
"city": "Everett",
"state": "WA",
"country_code": "US",
"postal_code": "982086642",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Marysville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.