Provider Demographics
NPI:1033231410
Name:EASTSIDE THERAPEUTIC RESOURCE
Entity Type:Organization
Organization Name:EASTSIDE THERAPEUTIC RESOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:425-443-9551
Mailing Address - Street 1:830 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6714
Mailing Address - Country:US
Mailing Address - Phone:425-443-9551
Mailing Address - Fax:425-828-0691
Practice Address - Street 1:830 6TH ST S
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6714
Practice Address - Country:US
Practice Address - Phone:425-443-9551
Practice Address - Fax:425-828-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty