MEDICARE: DR. KATHY NEWPORT MELMAN 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	103TC0700X	Clinical Psychologist	1080	WA

General Provider Information

NPI Number	:	1780735365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY NEWPORT MELMAN PH.D.

Provider Business Mailing Address
First Line	:	16040 CHRISTENSEN ROAD
Second Line	:	SUITE 217
City	:	SEATTLE
State	:	WA
Zip	:	98188-2966
Country	:	US
Telephone Number	:	206-244-9959
Fax Number	:	206-241-7346

Provider Business Practice Location Address
First Line	:	16040 CHRISTENSEN ROAD
Second Line	:	SUITE 217
City	:	SEATTLE
State	:	WA
Zip	:	98188-2966
Country	:	US
Telephone Number	:	206-244-9959
Fax Number	:	206-241-7346

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	10/06/2008

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