Healthcare Provider Details

I. General information

NPI: 1801015912
Provider Name (Legal Business Name): BASTYR UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 JUANITA DR NE
KENMORE WA
98028-4966
US

IV. Provider business mailing address

14500 JUANITA DR NE
KENMORE WA
98028-4966
US

V. Phone/Fax

Practice location:
  • Phone: 206-834-4100
  • Fax: 206-834-4131
Mailing address:
  • Phone: 206-834-4100
  • Fax: 206-834-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW JOHAN SIMON
Title or Position: DIRECTOR OF CLINICAL OPERATIONS
Credential: ND
Phone: 206-834-4100