Provider Demographics
NPI:1477061844
Name:CASCADE ALLERGY CENTER
Entity Type:Organization
Organization Name:CASCADE ALLERGY CENTER
Other - Org Name:CASCADE ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-261-8355
Mailing Address - Street 1:14205 SE 36TH ST STE 365
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14205 SE 36TH ST STE 365
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1596
Practice Address - Country:US
Practice Address - Phone:206-261-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60118915363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1821320938Medicaid