Healthcare Provider Details

I. General information

NPI: 1093964561
Provider Name (Legal Business Name): MICHELLE MARIE CANI BATTIN BA, MA, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE MARIE CANI BA, MA, PHD

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 165TH AVE NE
REDMOND WA
98052-3948
US

IV. Provider business mailing address

400 NW GILMAN BLVD UNIT 571
ISSAQUAH WA
98027-0292
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-2644
  • Fax: 425-867-0930
Mailing address:
  • Phone: 626-344-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26203
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60655194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: