Healthcare Provider Details

I. General information

NPI: 1831385624
Provider Name (Legal Business Name): WANDEE JOHNSON PRYOR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20174 FRONT ST NE
POULSBO WA
98370-7445
US

IV. Provider business mailing address

P.O. BOX 1611 THE FRONT STREET CLINIC
POULSBO WA
98370-7445
US

V. Phone/Fax

Practice location:
  • Phone: 360-697-1141
  • Fax:
Mailing address:
  • Phone: 360-697-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24125
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60412791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: