Healthcare Provider Details

I. General information

NPI: 1174401434
Provider Name (Legal Business Name): LUKE VAARTSTRA PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 NE 1ST ST STE 208
BELLEVUE WA
98005-3056
US

IV. Provider business mailing address

17076 165TH AVE SE
RENTON WA
98058-9592
US

V. Phone/Fax

Practice location:
  • Phone: 425-217-3546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: