=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255319117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA T. REHDER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2006
-----------------------------------------------------
Last Update Date | 09/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5252 116TH PL SE.
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-736-2758
-----------------------------------------------------
Fax | 253-446-3239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5252 116TH PL SE.
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-736-2758
-----------------------------------------------------
Fax | 253-446-3239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW0005396
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------