Healthcare Provider Details

I. General information

NPI: 1144980665
Provider Name (Legal Business Name): LASHAIAH DICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 RAINIER AVE S STE 201
SEATTLE WA
98144-4642
US

IV. Provider business mailing address

12728 28TH AVE NE APT 503
SEATTLE WA
98125-4385
US

V. Phone/Fax

Practice location:
  • Phone: 206-850-2009
  • Fax:
Mailing address:
  • Phone: 206-850-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: