Healthcare Provider Details

I. General information

NPI: 1275980922
Provider Name (Legal Business Name): MELINDA ENGBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE.
SEATTLE WA
98101
US

IV. Provider business mailing address

19456 SE 266TH ST
COVINGTON WA
98042-5037
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0930
  • Fax: 206-323-0933
Mailing address:
  • Phone: 206-724-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60232156
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: