Healthcare Provider Details

I. General information

NPI: 1437384419
Provider Name (Legal Business Name): MARK DENNIS ENGSTROM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1921 44TH AVE SW
SEATTLE WA
98116-1908
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-6216
  • Fax: 206-685-3244
Mailing address:
  • Phone: 773-227-7723
  • Fax: 206-685-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: