Healthcare Provider Details

I. General information

NPI: 1124946983
Provider Name (Legal Business Name): SUMMER J BLAUVELT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 2ND ST
SAN FRANCISCO CA
94105-3613
US

IV. Provider business mailing address

21717 SE 238TH ST
MAPLE VALLEY WA
98038-8567
US

V. Phone/Fax

Practice location:
  • Phone: 800-764-2935
  • Fax:
Mailing address:
  • Phone: 206-618-8734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60427108
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: