Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY19830 | CA |
N | 103T00000X | Psychologist | PSY19830 | CA |
Y | 102L00000X | Psychologist | PY60537543 | WA |
Y | 103T00000X | Psychologist | PY60537543 | WA |
NPI | 1013246057 |
---|---|
Provider Name | Dr. Lee P. Wong |
First Address | Seattle, WA 98124-3835 |
Second Address | Seattle, WA 98118-5569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2009 |
Last Update Date | 01/03/2019 |