Healthcare Provider Details

I. General information

NPI: 1659485738
Provider Name (Legal Business Name): RICHARD THEODORE WEMHOFF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 166TH AVE NE STE 200
REDMOND WA
98052-6629
US

IV. Provider business mailing address

8275 166TH AVE NE STE 200
REDMOND WA
98052-6629
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-2644
  • Fax: 425-867-0930
Mailing address:
  • Phone: 425-869-2644
  • Fax: 425-867-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: