1427352749 NPI number — SOUND CLINICAL ASSOCIATES PLLC

Table of content: (NPI 1427352749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427352749 NPI number — SOUND CLINICAL ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUND CLINICAL ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1427352749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4810 POINT FOSDICK DR NW
Provider Second Line Business Mailing Address:
PMB 27
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-710-3319
Provider Business Mailing Address Fax Number:
360-876-0878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2431 ANDERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-710-3319
Provider Business Practice Location Address Fax Number:
360-876-0878
Provider Enumeration Date:
12/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHILDRESS
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-710-3319

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30006700 , 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: 1427352749 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427352749 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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