Healthcare Provider Details

I. General information

NPI: 1538845391
Provider Name (Legal Business Name): SHAWN BLEICHERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

717 N 45TH ST APT 302
SEATTLE WA
98103-6500
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-4100
  • Fax:
Mailing address:
  • Phone: 518-836-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: