Basic Information
| Provider Information | |||||||||
| NPI: | 1245769116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHANEN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LSWAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34703 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067640502 | ||||||||
| FaxNumber: | 2537640516 | ||||||||
| Practice Location | |||||||||
| Address1: | 31405 18TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980035433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536816640 | ||||||||
| FaxNumber: | 2536816632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2017 | ||||||||
| LastUpdateDate: | 06/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SA60760336 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.