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115 Ne 100th St Seattle WA 98125-8099 | |
| (844) 867-8444 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 115 Ne 100th St, Seattle, Washington |
| Authorized Official Name and Position | Sonia Clark (CREDENTIALING MANAGER) |
| Authorized Official Contact | 4156366955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
360 Post St Ste 500 San Francisco CA 94108-4908 Ph: (844) 867-8444 | 115 Ne 100th St Seattle WA 98125-8099 Ph: (844) 867-8444 |
| NPI Number | 1417692740 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 06/09/2022 |
| Certification Date | 06/09/2022 |
| Medicare PECOS PAC ID | 7911382072 |
|---|---|
| Medicare Enrollment ID | O20220910000594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417692740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Christopher P Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093886178 PECOS PAC ID: 2860466679 Enrollment ID: I20040825001315 |
| Provider Name | Albert Wertz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093150138 PECOS PAC ID: 0941593438 Enrollment ID: I20170710000776 |
| Provider Name | Andrew R Jackenheimer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346569928 PECOS PAC ID: 1153612445 Enrollment ID: I20170825003308 |
| Provider Name | Michael James Speed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336709716 PECOS PAC ID: 4880922947 Enrollment ID: I20190827003530 |
| Provider Name | William Munroe Kamens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659733798 PECOS PAC ID: 6204252976 Enrollment ID: I20200812003470 |
| Provider Name | Jibran A Ahmed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992311823 PECOS PAC ID: 6507268687 Enrollment ID: I20210712003884 |
| Provider Name | Holly Bard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265054076 PECOS PAC ID: 4688086218 Enrollment ID: I20220907003115 |
| Provider Name | Taylor Ashley Osborne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114660867 PECOS PAC ID: 5799152625 Enrollment ID: I20221107002379 |
| Provider Name | Rebecca Boucher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063555431 PECOS PAC ID: 2264896455 Enrollment ID: I20230906002066 |
| Provider Name | Sophia Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902361157 PECOS PAC ID: 9830620855 Enrollment ID: I20241002000000 |
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