Healthcare Provider Details

I. General information

NPI: 1508046640
Provider Name (Legal Business Name): RAY NONE HENDRICKSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13716 LAKE CITY WAY NE APT 309
SEATTLE WA
98125-2601
US

IV. Provider business mailing address

13716 LAKE CITY WAY NE APT 309
SEATTLE WA
98125-2601
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-4004
  • Fax: 360-378-2787
Mailing address:
  • Phone: 360-298-4523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY2974
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY2974
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY2974
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPY2974
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002974
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY2974
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002974
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002974
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: