MEDICARE: DR. SEAN PATRICK CONGDON N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	NT00001043	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0118CO	OTHER	WA	REGENCE BLUESHIELD ID

General Provider Information

NPI Number	:	1659428779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN PATRICK CONGDON N.D.

Provider Business Mailing Address
First Line	:	424 24TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-4714
Country	:	US
Telephone Number	:	206-595-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	3670 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8004
Country	:	US
Telephone Number	:	206-834-4100
Fax Number	:	206-834-4131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	11/01/2007

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