Provider Demographics
NPI:1740880251
Name:BIELITZ, RUDOLPH ALEXANDER
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:ALEXANDER
Last Name:BIELITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 14TH AVE W APT 205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2167
Mailing Address - Country:US
Mailing Address - Phone:408-375-1417
Mailing Address - Fax:
Practice Address - Street 1:13555 NE BEL RED RD STE 228
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2324
Practice Address - Country:US
Practice Address - Phone:206-901-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician