Provider Demographics
NPI:1679648034
Name:A B C D INC
Entity Type:Organization
Organization Name:A B C D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUHAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-361-6884
Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:STE 225
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-361-6884
Mailing Address - Fax:206-361-1598
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:STE 225
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-361-6884
Practice Address - Fax:206-361-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103T00000X, 103TC0700X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA106922106922OtherPREMERA BLUECROSS
WAAA8105OtherREGENCE BLUESHIEDL
WA0008581622OtherAETNA