Provider Demographics
NPI:1114416120
Name:DUTHLER, RACHEL MARIE (LSWAIC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:DUTHLER
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 24TH PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1508
Mailing Address - Country:US
Mailing Address - Phone:616-481-9201
Mailing Address - Fax:
Practice Address - Street 1:16307 NE 83RD ST STE 204
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3867
Practice Address - Country:US
Practice Address - Phone:800-682-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608145111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical