Provider Demographics
NPI:1699243519
Name:BARKALOW, NICHOLAS SHANE
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SHANE
Last Name:BARKALOW
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 1:724 N 78TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4731
Mailing Address - Country:US
Mailing Address - Phone:719-651-1240
Mailing Address - Fax:
Practice Address - Street 1:724 N 78TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4731
Practice Address - Country:US
Practice Address - Phone:719-651-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1026117Medicaid