Healthcare Provider Details

I. General information

NPI: 1083829493
Provider Name (Legal Business Name): MS. MAGNITA SPENCE BLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date: 05/06/2014
Reactivation Date: 09/15/2025

III. Provider practice location address

16225 NE 87TH ST STE 160
REDMOND WA
98052-3536
US

IV. Provider business mailing address

18100 NE 95TH ST APT MM1066
REDMOND WA
98052-6912
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-2000
  • Fax:
Mailing address:
  • Phone:
  • 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: