Healthcare Provider Details

I. General information

NPI: 1699457291
Provider Name (Legal Business Name): REBECCA PETERS SCHELDRUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 3RD AVE
SEATTLE WA
98121-2385
US

IV. Provider business mailing address

1025 PARK PL APT 319
SAN MATEO CA
94403-7103
US

V. Phone/Fax

Practice location:
  • Phone: 206-432-3574
  • Fax:
Mailing address:
  • Phone: 650-576-1910
  • 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: