Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY61000110 | WA |
N | 103T00000X | Psychologist | PY61000110 | WA |
Y | 103TR0400X | Rehabilitation Psychologist | PY61000110 | WA |
NPI | 1710562533 |
---|---|
Provider Name | Kala M Phillips |
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 | 12/03/2021 |
Last Update Date | 12/03/2021 |