Basic Information
Provider Information
NPI: 1528609286
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENGLISH
FirstName: SYDNIE
MiddleName: ALIVIA
NamePrefix:  
NameSuffix:  
Credential: BA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6400 SOUTHCENTER BLVD
Address2:  
City: TUKWILA
State: WA
PostalCode: 981882547
CountryCode: US
TelephoneNumber: 2069012041
FaxNumber: 2069012010
Practice Location
Address1: 1600 E OLIVE ST
Address2:  
City: SEATTLE
State: WA
PostalCode: 981222735
CountryCode: US
TelephoneNumber: 2063022800
FaxNumber: 2063022810
Other Information
ProviderEnumerationDate: 10/03/2019
LastUpdateDate: 08/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000XCG61005235WAY Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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