Healthcare Provider Details

I. General information

NPI: 1790306520
Provider Name (Legal Business Name): MATTHEW ENKEMA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 5TH AVE STE 800
SEATTLE WA
98101-3136
US

IV. Provider business mailing address

1200 5TH AVE STE 800
SEATTLE WA
98101-3136
US

V. Phone/Fax

Practice location:
  • Phone: 206-755-8825
  • Fax:
Mailing address:
  • Phone: 206-755-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: