Provider Demographics
NPI:1841293735
Name:CASCADE PSYCHIATRIC SERVICES, PLLC
Entity type:Organization
Organization Name:CASCADE PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/COO
Authorized Official - Prefix:DR
Authorized Official - First Name:WOLFGANG
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-259-6665
Mailing Address - Street 1:3802 BROADWAY
Mailing Address - Street 2: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
Practice Address - Street 2: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
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8806457Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER