1891844924 NPI number — MRS. SHANNON DENISE MCCULLOCH-BENSON M.A.ED., AAC

Table of content: MRS. SHANNON DENISE MCCULLOCH-BENSON M.A.ED., AAC (NPI 1891844924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891844924 NPI number — MRS. SHANNON DENISE MCCULLOCH-BENSON M.A.ED., AAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCULLOCH-BENSON
Provider First Name:
SHANNON
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.ED., AAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891844924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 E OLIVE ST
Provider Second Line Business Mailing Address:
SOUND MENTAL HEALTH
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-302-2200
Provider Business Mailing Address Fax Number:
206-302-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-302-2600
Provider Business Practice Location Address Fax Number:
206-302-2610
Provider Enumeration Date:
01/09/2007

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: 101YM0800X , with the licence number:  CG60120647 , 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)





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