Healthcare Provider Details

I. General information

NPI: 1457787533
Provider Name (Legal Business Name): CENTRAL SEATTLE PANEL OF CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 12TH AVE STE 300
SEATTLE WA
98122-5523
US

IV. Provider business mailing address

411 12TH AVE STE 300
SEATTLE WA
98122-5523
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-2305
  • Fax: 206-343-9364
Mailing address:
  • Phone: 206-622-2305
  • Fax: 206-343-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MS. IRENE MARIE SUVER
Title or Position: OWNER
Credential:
Phone: 206-622-2305