Provider Demographics
NPI:1396077004
Name:CONNECTED WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:CONNECTED WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:TURCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-450-0100
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0097
Mailing Address - Country:US
Mailing Address - Phone:425-450-0100
Mailing Address - Fax:425-450-0200
Practice Address - Street 1:12501 BEL RED RD
Practice Address - Street 2:108
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2509
Practice Address - Country:US
Practice Address - Phone:425-450-0100
Practice Address - Fax:425-450-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNECTED WELLNESS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001073175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMT2049369OtherDEA