Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY0000035 | WA |
N | 103TC0700X | Clinical Psychologist | PY0000035 | WA |
N | 102L00000X | Psychologist | PY0000035 | WA |
N | 103T00000X | Psychologist | PY0000035 | WA |
N | 102L00000X | Psychologist | PY00000535 | WA |
N | 103T00000X | Psychologist | PY00000535 | WA |
N | 103G00000X | Clinical Psychologist | PY00000535 | WA |
N | 103TC0700X | Clinical Psychologist | PY00000535 | WA |
N | 103TF0000X | Family Psychologist | PY00000535 | WA |
N | 103TF0200X | Forensic Psychologist | PY00000535 | WA |
N | 103TH0100X | Health Service | PY00000535 | WA |
N | 103TS0200X | School Psychologist | PY00000535 | WA |
NPI | 1053457333 |
---|---|
Provider Name | Dr. Elizabeth Nyblade |
First Address | Bellingham, WA 98225-5232 |
Second Address | Bellingham, WA 98225-5232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |