Healthcare Provider Details

I. General information

NPI: 1538351085
Provider Name (Legal Business Name): INTERNATIONAL COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S OTHELLO ST 2ND FL.
SEATTLE WA
98118-3510
US

IV. Provider business mailing address

PO BOX 3007
SEATTLE WA
98114-3007
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax: 206-788-3521
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: PEGGY PHUNG
Title or Position: ASSISTANT FINANCE MANAGER
Credential:
Phone: 206-788-3605