Healthcare Provider Details

I. General information

NPI: 1841334786
Provider Name (Legal Business Name): SEACHANGE HEALTH & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/02/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 25TH AVE S UNIT A
SEATTLE WA
98144-4708
US

IV. Provider business mailing address

4412 CALIFORNIA AVE SW UNIT 16325
SEATTLE WA
98116-0816
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-9522
  • Fax: 877-883-1876
Mailing address:
  • Phone: 206-632-9522
  • Fax: 206-632-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberWA30002439
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH0006554
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLH00006554
License Number StateWA

VIII. Authorized Official

Name: KATHY J WILMERING
Title or Position: PRESIDENT
Credential: MSW ARNP
Phone: 206-632-9522