1841237609 NPI number — MICHAEL A O'CONNELL PHD, MSW

Table of content: MICHAEL A O'CONNELL PHD, MSW (NPI 1841237609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841237609 NPI number — MICHAEL A O'CONNELL PHD, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNELL
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, MSW
Provider Gender Code:
M

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:
1841237609
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:
16300 MILL CREEK BLVD
Provider Second Line Business Mailing Address:
202
Provider Business Mailing Address City Name:
MILL CREEK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98012-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-741-1405
Provider Business Mailing Address Fax Number:
425-745-5865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16300 MILL CREEK BLVD
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
MILL CREEK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98012-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-741-1405
Provider Business Practice Location Address Fax Number:
425-745-5865
Provider Enumeration Date:
06/01/2006

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:  LW00004619 , 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)