Provider Demographics
NPI:1033590252
Name:WOOLSEY, MANDI
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROY ST # 434
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4018
Mailing Address - Country:US
Mailing Address - Phone:206-384-4142
Mailing Address - Fax:
Practice Address - Street 1:24 ROY ST # 434
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4018
Practice Address - Country:US
Practice Address - Phone:206-384-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60569229103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst