Healthcare Provider Details

I. General information

NPI: 1679101802
Provider Name (Legal Business Name): AMY COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 NE CAMPUS PKWY 401 SCHMITZ
SEATTLE WA
98195
US

IV. Provider business mailing address

1410 NE CAMPUS PKWY 401 SCHMITZ
SEATTLE WA
98195
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-1240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number60321662
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: