NPIMap

Organization Active NPI

Encopresis Treatment Center

  • Health Service Clinic/Center
  • Edmonds, WA
National Provider Identifier
1306111562
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
602025306 Issued in WA
Legal business name
ENCOPRESIS TREATMENT CENTER
Practice address
611 Main St
Suite a
Edmonds, WA 98020-3096
Phone
(425) 640-3227
Fax
(425) 640-3478
NPI assigned
Mar 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Winifred K Waterbury
Title
Office Manager
Phone
(206) 629-4699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 602025306 WA Primary

Addresses

Primary practice location

611 Main St
Suite a
Edmonds, WA 98020-3096

Mailing address

1824 N. 203Rd Street
Shoreline, WA 98133
Phone (206) 629-4699

National Provider Directory

National Provider Directory

Locations

611 Main St
Ste A
Edmonds, WA 98020
Phone (425) 256-7798

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1306111562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 N. 203RD STREET",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98133",
            "telephone_number": "206-629-4699",
            "fax_number": "888-972-9414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 MAIN ST",
            "address_2": "SUITE A",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980203096",
            "telephone_number": "425-640-3227",
            "fax_number": "425-640-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCOPRESIS TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-20",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "WATERBURY",
        "authorized_official_first_name": "WINIFRED",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "206-629-4699"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "WA",
            "license": "602025306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.