Healthcare Provider Details

I. General information

NPI: 1053826321
Provider Name (Legal Business Name): CARLA ANN STESKAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NE 95TH ST
SEATTLE WA
98115-2426
US

IV. Provider business mailing address

2400 NE 95TH ST
SEATTLE WA
98115-2426
US

V. Phone/Fax

Practice location:
  • Phone: 206-517-0212
  • Fax: 206-525-9795
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60437245
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: