Healthcare Provider Details

I. General information

NPI: 1720693484
Provider Name (Legal Business Name): VANESSA PROSPER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 9TH AVE NE APT 300
SEATTLE WA
98115-5557
US

IV. Provider business mailing address

6404 9TH AVE NE APT 300
SEATTLE WA
98115-5557
US

V. Phone/Fax

Practice location:
  • Phone: 321-261-4181
  • Fax:
Mailing address:
  • Phone: 321-261-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY.70019774
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: