Healthcare Provider Details

I. General information

NPI: 1285286500
Provider Name (Legal Business Name): GREGORY V DEKLEVER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 NE 85TH ST STE 121
REDMOND WA
98052-3542
US

IV. Provider business mailing address

1550 EASTLAKE AVE E APT 204
SEATTLE WA
98102-3733
US

V. Phone/Fax

Practice location:
  • Phone: 425-903-3957
  • Fax: 425-868-5777
Mailing address:
  • Phone: 206-390-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60461630
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: