Provider Demographics
NPI:1912010729
Name:VALLEY WOMEN'S CLINIC PLLC
Entity Type:Organization
Organization Name:VALLEY WOMEN'S CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-228-0722
Mailing Address - Street 1:17722 TALBOT RD S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5744
Mailing Address - Country:US
Mailing Address - Phone:425-228-0722
Mailing Address - Fax:
Practice Address - Street 1:16850 SE 272ND ST STE 250
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4931
Practice Address - Country:US
Practice Address - Phone:253-630-3644
Practice Address - Fax:253-630-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7066772Medicaid
WA215101600Medicare ID - Type Unspecified