Healthcare Provider Details

I. General information

NPI: 1750597282
Provider Name (Legal Business Name): SHARON DIANE YOUNG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NW GILMAN BLVD SUITE 205
ISSAQUAH WA
98027-5349
US

IV. Provider business mailing address

12558 35TH AVE NE APT B
SEATTLE WA
98125-8910
US

V. Phone/Fax

Practice location:
  • Phone: 206-818-0158
  • Fax:
Mailing address:
  • Phone: 206-818-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60026311
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00002081
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: