Healthcare Provider Details

I. General information

NPI: 1740619295
Provider Name (Legal Business Name): HOLLEY KASKEL PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 E LAKE SAMMAMISH PKWY SE URBAN OASIS
SAMMAMISH WA
98075-7497
US

IV. Provider business mailing address

16541 REDMOND WAY #313C
REDMOND WA
98052-4492
US

V. Phone/Fax

Practice location:
  • Phone: 425-996-8592
  • Fax: 425-667-8402
Mailing address:
  • Phone: 425-996-8592
  • Fax: 425-667-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 60079992
License Number StateWA

VIII. Authorized Official

Name: DR. HOLLEY F KASKEL
Title or Position: OWNER
Credential: PSY.D.
Phone: 425-213-9153