Provider Demographics
NPI:1912697285
Name:BRESEE, DOMINIC JOSEPH
Entity Type:Individual
Prefix:MRS
First Name:DOMINIC
Middle Name:JOSEPH
Last Name:BRESEE
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 1:3008 NE 117TH ST SEATTLE WA 98125
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-910-4743
Mailing Address - Fax:
Practice Address - Street 1:12501 28TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4319
Practice Address - Country:US
Practice Address - Phone:206-684-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician