1427166081 NPI number — MS. TRACEY CHERYL BOSHOFF BA, MA, MHP

Table of content: MS. TRACEY CHERYL BOSHOFF BA, MA, MHP (NPI 1427166081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427166081 NPI number — MS. TRACEY CHERYL BOSHOFF BA, MA, MHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSHOFF
Provider First Name:
TRACEY
Provider Middle Name:
CHERYL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BA, MA, MHP
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:
1427166081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4011 WHITMAN AVE N APT 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98103-7800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-856-9140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3322 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-349-6877
Provider Business Practice Location Address Fax Number:
425-349-6855
Provider Enumeration Date:
08/25/2006

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: 1041C0700X , with the licence number:  RC00043058 , 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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