| Crescent Wellness, Inc | |
|
320 Dayton St Ste 127 Edmonds WA 98020-3590 | |
| (206) 486-0295 | |
| Not Available |
| Full Name | Crescent Wellness, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 320 Dayton St Ste 127, Edmonds, Washington |
| Authorized Official Name and Position | Kelly Druin (PROVIDER) |
| Authorized Official Contact | 2064860295 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Wellness, Inc 320 Dayton St Ste 127 Edmonds WA 98020-3590 Ph: () - | Crescent Wellness, Inc 320 Dayton St Ste 127 Edmonds WA 98020-3590 Ph: (206) 486-0295 |
| NPI Number | 1124594510 |
|---|---|
| Provider Enumeration Date | 10/23/2018 |
| Last Update Date | 05/22/2022 |
| Certification Date | 05/22/2022 |
| Medicare PECOS PAC ID | 9234482456 |
|---|---|
| Medicare Enrollment ID | O20181105001783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124594510 | NPI | - | NPPES |
| 1649586777 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kelly D Sievertson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649586777 PECOS PAC ID: 2264687318 Enrollment ID: I20130221000487 |
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