Healthcare Provider Details

I. General information

NPI: 1275117095
Provider Name (Legal Business Name): SCOTT SHIEBLER PHD, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 NE CAMPUS PKWY
SEATTLE WA
98195-0003
US

IV. Provider business mailing address

15556 GREENWOOD AVE N
SHORELINE WA
98133-5912
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-1240
  • Fax:
Mailing address:
  • Phone: 206-543-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY00003187
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: