1235393422 NPI number — RISA LEANNE SALTERS LSWAIC

Table of content: VICKI THOMPSON (NPI 1285588541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235393422 NPI number — RISA LEANNE SALTERS LSWAIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALTERS
Provider First Name:
RISA
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSWAIC
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:
1235393422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12110 SE 312TH ST APT F203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98092-3353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-389-5603
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WESTERN STATE HOSPITAL 9601 STEILACOOM BLVD. SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-984-5870
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2008

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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