Healthcare Provider Details

I. General information

NPI: 1831176320
Provider Name (Legal Business Name): ROBERT E PARKER PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19987 1ST AVE S #101
NORMANDY PARK WA
98148
US

IV. Provider business mailing address

19987 1ST AVE S #101
NORMANDY PARK WA
98148
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-7275
  • Fax:
Mailing address:
  • Phone: 206-824-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1487
License Number StateWA

VIII. Authorized Official

Name: DR. ROBERT E PARKER
Title or Position: OWNER PSYCHOLOGIST
Credential: PHD
Phone: 206-824-7275