Provider Demographics
NPI:1437355609
Name:STEIN, ILENE (RN, MSW)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:RN, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 NW 57TH ST
Mailing Address - Street 2:427
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5641
Mailing Address - Country:US
Mailing Address - Phone:206-789-7145
Mailing Address - Fax:
Practice Address - Street 1:1545 NW 57TH ST
Practice Address - Street 2:427
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5644
Practice Address - Country:US
Practice Address - Phone:206-789-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000066971041C0700X
WARN00073945163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical