Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY60014648 | WA |
N | 103TC0700X | Clinical Psychologist | PY60014648 | WA |
N | 103G00000X | Clinical Psychologist | PY60014648 | WA |
N | 103TC0700X | Clinical Psychologist | PY60014648 | WA |
Y | 103TR0400X | Rehabilitation Psychologist | PY60014648 | WA |
NPI | 1568625895 |
---|---|
Provider Name | Dr. Brenda Kay Havellana |
First Address | Marysville, WA 98270-6804 |
Second Address | Lynnwood, WA 98036-6397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 23/06/2011 |