MEDICARE: PATRICIA RAE PRINGLE

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	101YM0800X	Mental Health Counselor	LH00005443	WA
2	1041C0700X	Clinical Social Worker	LW00005670	WA

General Provider Information

NPI Number	:	1609027564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA RAE PRINGLE

Provider Business Mailing Address
First Line	:	704 228TH AVE NE
Second Line	:	# 267
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7222
Country	:	US
Telephone Number	:	425-802-4664
Fax Number	:	425-868-8928

Provider Business Practice Location Address
First Line	:	704 228TH AVE NE
Second Line	:	# 267
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7222
Country	:	US
Telephone Number	:	425-802-4664
Fax Number	:	425-868-8928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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Directions to “ PATRICIA RAE PRINGLE ” Practice Location

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