Healthcare Provider Details

I. General information

NPI: 1235521014
Provider Name (Legal Business Name): SEATTLE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19213 BOTHELL WAY NE
BOTHELL WA
98011-2939
US

IV. Provider business mailing address

19213 BOTHELL WAY NE
BOTHELL WA
98011-2939
US

V. Phone/Fax

Practice location:
  • Phone: 425-488-6173
  • Fax:
Mailing address:
  • Phone: 425-488-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number178019356
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KELLY WALLACE
Title or Position: SVP AND CFO
Credential:
Phone: 206-987-2004