Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY60155493 | WA |
N | 103T00000X | Psychologist | PY60155493 | WA |
Y | 103TR0400X | Rehabilitation Psychologist | PY60155493 | WA |
NPI | 1063841641 |
---|---|
Provider Name | Tiara Dillworth |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 20/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063841641 | (05) | WA |