Provider Demographics
NPI:1093069296
Name:DOCKTER, ISAAC STEPHEN
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:STEPHEN
Last Name:DOCKTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 RAINIER AVE S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2000
Mailing Address - Country:US
Mailing Address - Phone:425-255-5526
Mailing Address - Fax:425-255-5523
Practice Address - Street 1:140 RAINIER AVE S
Practice Address - Street 2:SUITE 3
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2000
Practice Address - Country:US
Practice Address - Phone:425-255-5526
Practice Address - Fax:425-255-5523
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60153647101YA0400X
WACL60174034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health