Basic Information
Provider Information
NPI: 1710179270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALE
FirstName: EDWARD
MiddleName:  
NamePrefix: MR.
NameSuffix: IV
Credential: BA, RC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 E OLIVE ST
Address2:  
City: SEATTLE
State: WA
PostalCode: 981222735
CountryCode: US
TelephoneNumber: 2063022200
FaxNumber: 2063022210
Practice Location
Address1: 505 29TH ST SE
Address2:  
City: AUBURN
State: WA
PostalCode: 980027541
CountryCode: US
TelephoneNumber: 2538767650
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2007
LastUpdateDate: 08/17/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XRC00055440WAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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