Healthcare Provider Details

I. General information

NPI: 1538524921
Provider Name (Legal Business Name): BRENT PRITCHARD LSWAIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25944 COMMUNITY PLAZA WAY
SEDRO WOOLLEY WA
98284-9702
US

IV. Provider business mailing address

25944 COMMUNITY PLAZA WAY
SEDRO WOOLLEY WA
98284-9702
US

V. Phone/Fax

Practice location:
  • Phone: 360-854-7067
  • Fax:
Mailing address:
  • Phone: 360-854-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60536435
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61123638
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: