Healthcare Provider Details

I. General information

NPI: 1518896596
Provider Name (Legal Business Name): GRACE MARIE COUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18737 68TH AVE NE
KENMORE WA
98028-2606
US

IV. Provider business mailing address

14201 174TH AVE NE
REDMOND WA
98052-1252
US

V. Phone/Fax

Practice location:
  • Phone: 425-939-1377
  • Fax:
Mailing address:
  • Phone: 425-681-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: