Provider Demographics
NPI:1184190076
Name:POWDERLY, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:POWDERLY
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 1:12430 83RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4918
Mailing Address - Country:US
Mailing Address - Phone:206-930-2438
Mailing Address - Fax:
Practice Address - Street 1:12430 83RD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-4918
Practice Address - Country:US
Practice Address - Phone:206-930-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician