Healthcare Provider Details

I. General information

NPI: 1245972736
Provider Name (Legal Business Name): ANNIE LAI SAEPHANH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9714 3RD AVE NE STE 206
SEATTLE WA
98115-2046
US

IV. Provider business mailing address

9714 3RD AVE NE STE 206
SEATTLE WA
98115-2046
US

V. Phone/Fax

Practice location:
  • Phone: 206-636-1101
  • Fax:
Mailing address:
  • Phone: 206-636-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: