Provider Demographics
NPI:1609027564
Name:PRINGLE, PATRICIA RAE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RAE
Last Name:PRINGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 228TH AVE NE
Mailing Address - Street 2:# 267
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7222
Mailing Address - Country:US
Mailing Address - Phone:425-802-4664
Mailing Address - Fax:425-868-8928
Practice Address - Street 1:704 228TH AVE NE
Practice Address - Street 2:# 267
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7222
Practice Address - Country:US
Practice Address - Phone:425-802-4664
Practice Address - Fax:425-868-8928
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005443101YM0800X
WALW000056701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health