Provider Demographics
NPI:1174171458
Name:NORTHWEST KETAMINE CLINICS PLLC DBA NORTHWEST HEALING AND WELLNESS
Entity type:Organization
Organization Name:NORTHWEST KETAMINE CLINICS PLLC DBA NORTHWEST HEALING AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:206-330-6722
Mailing Address - Street 1:35302 SE CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9216
Mailing Address - Country:US
Mailing Address - Phone:206-309-2299
Mailing Address - Fax:425-256-3250
Practice Address - Street 1:1750 112TH AVE NE STE C228
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3773
Practice Address - Country:US
Practice Address - Phone:206-309-2299
Practice Address - Fax:425-256-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty