Healthcare Provider Details

I. General information

NPI: 1710012547
Provider Name (Legal Business Name): NORTHWEST CENTER - CHILD DEVELOPMENT PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 09/02/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S 144TH ST
SEATAC WA
98168-3702
US

IV. Provider business mailing address

7272 W MARGINAL WAY S
SEATTLE WA
98108
US

V. Phone/Fax

Practice location:
  • Phone: 206-285-9140
  • Fax: 206-764-8273
Mailing address:
  • Phone: 206-285-9140
  • Fax: 206-764-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LORI DOLAN
Title or Position: CONTROLLER
Credential:
Phone: 206-285-9140