Healthcare Provider Details

I. General information

NPI: 1013081454
Provider Name (Legal Business Name): GRACEWINDS PERINATAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 NW 70TH ST
SEATTLE WA
98117-5340
US

IV. Provider business mailing address

1415 NW 70TH ST
SEATTLE WA
98117-5340
US

V. Phone/Fax

Practice location:
  • Phone: 206-781-9871
  • Fax: 206-297-8488
Mailing address:
  • Phone: 206-781-9871
  • Fax: 206-297-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE CLAIR WALLACE
Title or Position: PRESIDENT CEO
Credential: CMA, LMP, CCCE, CLD
Phone: 206-781-9871