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General NPI Number Information
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NPI Number | 1518264407
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Entity Type | Organization
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Legal Business Name | PATRICIA FANTONI-SALVADOR, PH.D., LLC.
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 10740 MERIDIAN AVE N STE 110
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City | SEATTLE
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State | WA
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Zip | 98133-9010
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Country | US
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Telephone | 206-257-1061
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Fax | 206-257-1061
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Provider Business Mailing Address
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Address Line | 10002 AURORA AVE N STE 36
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City | SEATTLE
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State | WA
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Zip | 98133-9348
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Country | US
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Telephone | 206-257-1061
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Fax | 206-257-1061
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Authorized Official
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Title or Position | MANAGER
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Name | PATRICIA FANTONI-SALVADOR
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Credential |
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Telephone | 206-257-1061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY 60199015
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License Number State | WA
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