Healthcare Provider Details

I. General information

NPI: 1679320071
Provider Name (Legal Business Name): INNER CANVAS SP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S JACKSON ST STE 301
SEATTLE WA
98104-2872
US

IV. Provider business mailing address

2445 SQUAK MOUNTAIN LOOP SW
ISSAQUAH WA
98027-4423
US

V. Phone/Fax

Practice location:
  • Phone: 425-526-9575
  • Fax:
Mailing address:
  • Phone: 206-356-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA KRUEGER
Title or Position: OWNER / PSYCHOTHERAPIST
Credential: LMHC, LMFT
Phone: 425-526-9575