Provider Demographics
NPI:1144377094
Name:CHILDRENS HOSPITAL
Entity Type:Organization
Organization Name:CHILDRENS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DE MASO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-987-2000
Mailing Address - Street 1:1205 NE 88TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3126
Mailing Address - Country:US
Mailing Address - Phone:206-987-2000
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:206-987-2000
Practice Address - Fax:425-451-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007347261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities