# LAKE FOREST PARK CLINIC TR

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Forest Park Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548222102
- **Authorized official:** MRS. CHARLES WILLIAM SCHNEIDER (PRES/CEO)
- **Authorized official phone:** (206) 368-1700

## Contact information

- **Practice address:** 17191 BOTHELL WAY NE, LAKE FOREST PARK, WA 98155-5534
- **Practice address phone:** (206) 365-6768
- **Practice address fax:** (206) 364-5418
- **Mailing address:** 17191 BOTHELL WAY NE, SUITE 205, LAKE FOREST PARK, WA 98155-5534
- **Mailing address phone:** (206) 365-6768
- **Mailing address fax:** (206) 364-5418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/06/2006
- **Last updated:** 04/21/2011