Healthcare Provider Details

I. General information

NPI: 1750813374
Provider Name (Legal Business Name): WILLIAM JUSTIN SEWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 04/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 BROADWAY
EVERETT WA
98201-4425
US

IV. Provider business mailing address

2402 RUCKER AVE
EVERETT WA
98201-5716
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-6200
  • Fax:
Mailing address:
  • Phone: 206-501-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: