Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY 60666097 | WA |
Y | 103T00000X | Psychologist | PY 60666097 | WA |
NPI | 1013340793 |
---|---|
Provider Name | Vanessa G Dzivakwe |
First Address | Seattle, WA 98101-1726 |
Second Address | Seattle, WA 98101-1726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2013 |
Last Update Date | 17/03/2018 |