Healthcare Provider Details

I. General information

NPI: 1740846468
Provider Name (Legal Business Name): KASEY FAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

IV. Provider business mailing address

17500 25TH AVE NE UNIT J104
MARYSVILLE WA
98271-4810
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-3186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCG60967496
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: