Provider Demographics
NPI:1265679823
Name:SCHULZ, JOEL ALLEN (CP)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ALLEN
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 218TH ST SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2180
Mailing Address - Country:US
Mailing Address - Phone:425-771-0797
Mailing Address - Fax:202-219-1144
Practice Address - Street 1:6405 218TH ST SW
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2180
Practice Address - Country:US
Practice Address - Phone:425-771-0797
Practice Address - Fax:202-219-1144
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist