Healthcare Provider Details

I. General information

NPI: 1477535789
Provider Name (Legal Business Name): GEORGANNA R SEDLAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NW MAPLE ST STE 210
ISSAQUAH WA
98027
US

IV. Provider business mailing address

3223 NE MARQUETTE WAY
ISSAQUAH WA
98029-3635
US

V. Phone/Fax

Practice location:
  • Phone: 425-835-2788
  • Fax:
Mailing address:
  • Phone: 916-224-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60317237
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number19644
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number60317237
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: