Healthcare Provider Details

I. General information

NPI: 1063628576
Provider Name (Legal Business Name): VALLEY CHILDREN'S CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S STE 220
RENTON WA
98055-5791
US

IV. Provider business mailing address

4011 TALBOT RD S STE 220
RENTON WA
98055-5791
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5300
  • Fax:
Mailing address:
  • Phone: 425-656-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY MCBRIDE
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 425-656-5350