1528043015 NPI number — AIMEE C SEELY-FADICH

Table of content: AIMEE C SEELY-FADICH (NPI 1528043015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528043015 NPI number — AIMEE C SEELY-FADICH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEELY-FADICH
Provider First Name:
AIMEE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEELY
Provider Other First Name:
AIMEE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528043015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98038-0350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-358-0956
Provider Business Mailing Address Fax Number:
877-481-6931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 N EMERSON AVE
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-6619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-663-2157
Provider Business Practice Location Address Fax Number:
509-663-7272
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  LD00002103 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1044574 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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