Provider Demographics
NPI:1578106324
Name:PATTERSON, ADRYENNE (MSW, LICSWA, MHP)
Entity Type:Individual
Prefix:
First Name:ADRYENNE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MSW, LICSWA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 24TH AVE S STE 260
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4644
Mailing Address - Country:US
Mailing Address - Phone:253-382-5340
Mailing Address - Fax:
Practice Address - Street 1:16715 AURORA AVE N # 102
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5310
Practice Address - Country:US
Practice Address - Phone:206-546-9766
Practice Address - Fax:206-542-0326
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61106896101YA0400X
390200000X
WASC61194721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1026117Medicaid