Healthcare Provider Details

I. General information

NPI: 1841349446
Provider Name (Legal Business Name): VIRGINIA M. BUZZELL PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 DAYTON ST STE D
EDMONDS WA
98020-3476
US

IV. Provider business mailing address

18540 63RD AVE NE
KENMORE WA
98028-8919
US

V. Phone/Fax

Practice location:
  • Phone: 425-330-0421
  • Fax:
Mailing address:
  • Phone: 425-330-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60048804
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: