CASCADE PSYCHIATRIC SERVICES, PSC

Provider Demographics

• NPI: 1770737934
• Name: CASCADE PSYCHIATRIC SERVICES, PSC
• Entity type: Organization
• Organization Name: CASCADE PSYCHIATRIC SERVICES, PSC
• Authorized Official - Title/Position: CHIEF OPERATING OFFICER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: WOLFGANG
• Authorized Official - Middle Name: W
• Authorized Official - Last Name: KLAMP
• Authorized Official - Credentials: PHD, MBA
• Authorized Official - Phone: 425-259-6665
• Mailing Address - Street 1: 3802 BROADWAY STE B
• Mailing Address - City: EVERETT
• Mailing Address - State: WA
• Mailing Address - Zip Code: 98201-5032
• Mailing Address - Country: US
• Mailing Address - Phone: 425-259-6665
• Mailing Address - Fax: 425-259-6014
• Practice Address - Street 1: 3802 BROADWAY STE B
• Practice Address - City: EVERETT
• Practice Address - State: WA
• Practice Address - Zip Code: 98201-5032
• Practice Address - Country: US
• Practice Address - Phone: 425-259-6665
• Practice Address - Fax: 425-259-6014
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-11-13
• Last Update Date: 2008-11-13

Provider Licenses

State	License ID	Taxonomies
WA	AP30007181	101YM0800X
WA	MD00023385	103T00000X
WA	MD00045550	103T00000X
WA	MD00009424	103T00000X
WA	AP30007788	103T00000X
WA	MD00035512	103T00000X
WA	MD00042238	2084P0800X
WA	MD00037882	2084P0805X
WA	PA10003235	363A00000X
WA	AP30007333	363LP0808X
		174400000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	174400000X	Other Service Providers	Specialist		Group - Single Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Single Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Single Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Single Specialty
No	2084P0805X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Geriatric Psychiatry	Group - Single Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Single Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	1073575601	Other	CMS
WA	1134178882	Other	CMS
WA	1144276759	Other	CMS
WA	1417920810	Other	CMS
WA	1972632560	Other	CMS
WA	1013009273	Other	CMS
OR	1114077138	Other	CMS
WA	1902097355	Other	CMS
WA	1275724627	Other	CMS
WA	1477713113	Other	CMS