MEDICARE: THERESE ALLEN & CO.

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1952982936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESE ALLEN & CO.

Provider Business Mailing Address
First Line	:	22207 7TH AVE S STE A
Second Line	:
City	:	DES MOINES
State	:	WA
Zip	:	98198-6221
Country	:	US
Telephone Number	:	206-414-9979
Fax Number	:

Provider Business Practice Location Address
First Line	:	22207 7TH AVE S STE A
Second Line	:
City	:	DES MOINES
State	:	WA
Zip	:	98198-6221
Country	:	US
Telephone Number	:	206-414-9979
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ELAINE ZENG
Credential	:
Telephone Number	:	206-414-9979

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/21/2021

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