Provider Demographics
NPI:1710012547
Name:NORTHWEST CENTER - CHILD DEVELOPMENT PROGRAM
Entity Type:Organization
Organization Name:NORTHWEST CENTER - CHILD DEVELOPMENT PROGRAM
Other - Org Name:NORTHWEST CENTER FOR THE RETARDED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-378-6360
Mailing Address - Street 1:7272 W MARGINAL WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108
Mailing Address - Country:US
Mailing Address - Phone:206-285-9140
Mailing Address - Fax:206-764-8273
Practice Address - Street 1:7272 W MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108
Practice Address - Country:US
Practice Address - Phone:206-285-9140
Practice Address - Fax:206-764-8273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1026246Medicaid
WA7681034Medicaid
WA7014954Medicaid