Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | PY61015036 | WA |
NPI | 1508459314 |
---|---|
Provider Name | Tracy E. Herring |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98133-8401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2021 |
Last Update Date | 12/02/2021 |