Healthcare Provider Details

I. General information

NPI: 1215698352
Provider Name (Legal Business Name): MICHELLE JEAN TAYLOR CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST # 356154
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4487
  • Fax: 206-598-4897
Mailing address:
  • Phone: 206-598-5845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00118132
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: