Healthcare Provider Details

I. General information

NPI: 1750436143
Provider Name (Legal Business Name): DIANNA K ALTENA R.N., LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE MS W3636
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-0000
  • Fax:
Mailing address:
  • Phone: 206-987-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004680
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN00045814
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW00004680
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: