| Regina A Blackwolf, Msw | |
|
12812 3rd Ave Se Ste A Everett WA 98208-6455 | |
| (206) 375-7657 | |
| (206) 319-5325 |
| Full Name | Regina A Blackwolf, Msw |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12812 3rd Ave Se Ste A, Everett, Washington |
| Authorized Official Name and Position | Regina A Blackwolf (PRESIDENT, MEMBER, THERAPIST) |
| Authorized Official Contact | 2063757657 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regina A Blackwolf, Msw 12812 3rd Ave Se Ste A Everett WA 98208-6455 Ph: (206) 375-7657 | Regina A Blackwolf, Msw 12812 3rd Ave Se Ste A Everett WA 98208-6455 Ph: (206) 375-7657 |
| NPI Number | 1811326804 |
|---|---|
| Provider Enumeration Date | 11/11/2013 |
| Last Update Date | 03/03/2023 |
| Certification Date | 03/03/2023 |
| Medicare PECOS PAC ID | 7113256090 |
|---|---|
| Medicare Enrollment ID | O20190903002441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811326804 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LW60083962 (Washington) | Primary |
| Provider Name | Regina A Blackwolf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184777252 PECOS PAC ID: 8325184922 Enrollment ID: I20091013000411 |
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