Provider Demographics
NPI:1538894936
Name:SACHS, THADDEUS VAN ROBERT (BS)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:VAN ROBERT
Last Name:SACHS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16323 48TH AVE W UNIT 9
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4809
Mailing Address - Country:US
Mailing Address - Phone:425-622-3590
Mailing Address - Fax:
Practice Address - Street 1:6505 218TH ST SW STE 12
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2135
Practice Address - Country:US
Practice Address - Phone:206-565-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician