Provider Demographics
NPI:1720230568
Name:WEISBROD, SHEILA M
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:WEISBROD
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 1:15118 MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1653
Mailing Address - Country:US
Mailing Address - Phone:206-498-1413
Mailing Address - Fax:
Practice Address - Street 1:15118 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1653
Practice Address - Country:US
Practice Address - Phone:206-498-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60095913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health