Provider Demographics
NPI:1114264892
Name:SERVICE, RHIANNON MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:RHIANNON
Middle Name:MARIE
Last Name:SERVICE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3032
Mailing Address - Country:US
Mailing Address - Phone:206-788-3700
Mailing Address - Fax:206-962-3297
Practice Address - Street 1:15150 140TH WAY SE
Practice Address - Street 2:#S201
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7834
Practice Address - Country:US
Practice Address - Phone:801-814-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60677241101YM0800X
WAFC60652989101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health