Healthcare Provider Details

I. General information

NPI: 1942073697
Provider Name (Legal Business Name): WILLIAM R OHLSTROM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 3RD AVE STE 116
SEATTLE WA
98121-2353
US

IV. Provider business mailing address

7711 NE 175TH ST UNIT A205
KENMORE WA
98028-3570
US

V. Phone/Fax

Practice location:
  • Phone: 206-432-3574
  • Fax:
Mailing address:
  • Phone: 425-287-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: