| Michael Boltwood , Inc | |
|
6000 Whale Dancer Ct Ne Suquamish WA 98392-9648 | |
| (360) 698-1321 | |
| (360) 308-0447 |
| Full Name | Michael Boltwood , Inc |
|---|---|
| Speciality | Psychologist |
| Location | 6000 Whale Dancer Ct Ne, Suquamish, Washington |
| Authorized Official Name and Position | Michael Boltwood (OWNER) |
| Authorized Official Contact | 3606981321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Boltwood , Inc Po Box 2324 Silverdale WA 98383-2324 Ph: (360) 698-1321 | Michael Boltwood , Inc 6000 Whale Dancer Ct Ne Suquamish WA 98392-9648 Ph: (360) 698-1321 |
| NPI Number | 1427231307 |
|---|---|
| Provider Enumeration Date | 12/13/2007 |
| Last Update Date | 12/30/2022 |
| Certification Date | 12/30/2022 |
| Medicare PECOS PAC ID | 8729044417 |
|---|---|
| Medicare Enrollment ID | O20041203000994 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427231307 | NPI | - | NPPES |
| 7069149 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY00001641 (Washington) | Primary |
| Provider Name | Michael D Boltwood |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487739694 PECOS PAC ID: 1254396138 Enrollment ID: I20041120000123 |
Suquamish Wellness Center Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 18490 Suquamish Way Ne Unit 107, Suquamish, WA 98392 Phone: 360-394-8558 Fax: 360-598-1724 |