Healthcare Provider Details

I. General information

NPI: 1669740353
Provider Name (Legal Business Name): PAMELA VAN DALFSEN, PH.D., INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 E MADISON ST SUITE 300
SEATTLE WA
98112-4265
US

IV. Provider business mailing address

2915 E MADISON ST SUITE 300
SEATTLE WA
98112-4265
US

V. Phone/Fax

Practice location:
  • Phone: 206-325-7222
  • Fax:
Mailing address:
  • Phone: 206-325-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY0001274
License Number StateWA

VIII. Authorized Official

Name: DR. PAMELA J VAN DALFSEN
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 206-325-7222