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3429 Fremont Ave N Ste 317 Seattle WA 98103-8811 | |
| (206) 300-2452 | |
| (206) 567-1212 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 3429 Fremont Ave N Ste 317, Seattle, Washington |
| Authorized Official Name and Position | Samantha Lea Slaughter (CEO) |
| Authorized Official Contact | 2063002452 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3429 Fremont Ave N Ste 317 Seattle WA 98103-8811 Ph: (206) 300-2452 | 3429 Fremont Ave N Ste 317 Seattle WA 98103-8811 Ph: (206) 300-2452 |
| NPI Number | 1912254913 |
|---|---|
| Provider Enumeration Date | 08/08/2012 |
| Last Update Date | 07/20/2020 |
| Certification Date | 07/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912254913 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY60075756 (Washington) | Primary |
| 225100000X | Physical Therapist | PT60265736 (Washington) | Secondary |
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