Healthcare Provider Details

I. General information

NPI: 1568511749
Provider Name (Legal Business Name): KAREN MICHELE SIEGEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-4167
US

IV. Provider business mailing address

11231 BORGEN LOOP
GIG HARBOR WA
98332-5712
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4938
  • Fax:
Mailing address:
  • Phone: 619-977-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2669
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2669
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2669
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number2669
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: