1447452263 NPI number — SHERYL LYNN MATTAUSCH BA, CDP

Table of content: SHERYL LYNN MATTAUSCH BA, CDP (NPI 1447452263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447452263 NPI number — SHERYL LYNN MATTAUSCH BA, CDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTAUSCH
Provider First Name:
SHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, CDP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUTTLE
Provider Other First Name:
TAYLOR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447452263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
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:
4238 AUBURN WAY N
Provider Second Line Business Practice Location Address:
SOUND MENTAL HEALTH
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-302-2200
Provider Business Practice Location Address Fax Number:
206-302-2210
Provider Enumeration Date:
06/04/2007

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: 101YA0400X , with the licence number:  CP60119721 , 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)