Healthcare Provider Details

I. General information

NPI: 1821040700
Provider Name (Legal Business Name): GARY ALAN WALCO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE SEATTLE CHILDREN'S HOSPITAL
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE SEATTLE CHILDREN'S HOSPITAL
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2704
  • Fax: 206-987-3935
Mailing address:
  • Phone: 206-987-2704
  • Fax: 206-987-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 60066173
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY 60066173
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number60066173
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: