1356897904 NPI number — MRS. KARA VALERIE SEIBERT MSW

Table of content: MRS. KARA VALERIE SEIBERT MSW (NPI 1356897904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356897904 NPI number — MRS. KARA VALERIE SEIBERT MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIBERT
Provider First Name:
KARA
Provider Middle Name:
VALERIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356897904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1678
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98668-1678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-397-8246
Provider Business Mailing Address Fax Number:
360-397-8448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E FOURTH PLAIN BLVD BLDG 17 STE A212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-397-8246
Provider Business Practice Location Address Fax Number:
360-397-8448
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201746765WA , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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