Healthcare Provider Details

I. General information

NPI: 1477417723
Provider Name (Legal Business Name): CLARE MARIE RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E COTA ST
SHELTON WA
98584
US

IV. Provider business mailing address

3725 ENSIGN RD NE
OLYMPIA WA
98506-5089
US

V. Phone/Fax

Practice location:
  • Phone: 360-205-8001
  • Fax: 360-836-2820
Mailing address:
  • Phone: 206-280-0327
  • Fax: 360-836-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00167623
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: