MEDICARE: DR. BARBARA STUART PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY00001537	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ST3391	OTHER	WA	REGENCE BLUE SHIELD NUMBE

General Provider Information

NPI Number	:	1497809180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA STUART PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98020-0236
Country	:	US
Telephone Number	:	425-771-4548
Fax Number	:	425-771-5678

Provider Business Practice Location Address
First Line	:	6869 WOODLAWN AVE NE
Second Line	:	SUITE 100
City	:	SEATTLE
State	:	WA
Zip	:	98115-5469
Country	:	US
Telephone Number	:	425-771-4548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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