Healthcare Provider Details

I. General information

NPI: 1962655399
Provider Name (Legal Business Name): ELIZABETH KUNCHANDY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17544 MIDVALE AVE N STE 207
SHORELINE WA
98133-4921
US

IV. Provider business mailing address

17523 19TH CT NE
SHORELINE WA
98155-5262
US

V. Phone/Fax

Practice location:
  • Phone: 206-999-4587
  • Fax: 206-770-7303
Mailing address:
  • Phone: 206-999-4587
  • Fax: 206-770-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: