Basic Information
| Provider Information | |||||||||
| NPI: | 1194191171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARNER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | WARNER | ||||||||
| OtherFirstName: | TRISH | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | BAS AHP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15903 3RD AVE NE | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981555713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604415215 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10521 MERIDIAN AVE N | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981339509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062964990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2015 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 60582351 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 101Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.