Healthcare Provider Details

I. General information

NPI: 1114456035
Provider Name (Legal Business Name): NICKOLAS ARION DASHER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC STREET BOX 356490
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-227-1199
  • Fax:
Mailing address:
  • Phone: 206-543-9061
  • Fax: 206-685-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY60740281
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: