Healthcare Provider Details

I. General information

NPI: 1255873857
Provider Name (Legal Business Name): CHAD JOSEPH SANDERS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 201
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 201
PULLMAN WA
99163-5517
US

V. Phone/Fax

Practice location:
  • Phone: 509-339-2394
  • Fax:
Mailing address:
  • Phone: 509-338-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY60683489
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60683489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: