MEDICARE: MOONSTRUCK PATHWAYS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164365870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONSTRUCK PATHWAYS, PLLC

Provider Business Mailing Address
First Line	:	522 W RIVERSIDE AVE STE N
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 HARBOR AVE SW # 233
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-2394
Country	:	US
Telephone Number	:	425-448-5988
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HANNAH SOMMERFELD
Credential	:
Telephone Number	:	425-448-5988

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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