Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 60773681 | WA |
NPI | 1194245308 |
---|---|
Provider Name | Dr. Amy Jo Starosta |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 26/09/2017 |