Healthcare Provider Details

I. General information

NPI: 1164647046
Provider Name (Legal Business Name): HARRY C DUDLEY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 NE 41ST ST SUITE 310
VANCOUVER WA
98662-6791
US

IV. Provider business mailing address

7600 NE 41ST ST SUITE 310
VANCOUVER WA
98662-6728
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-6425
  • Fax: 360-253-3196
Mailing address:
  • Phone: 360-253-6425
  • Fax: 360-253-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1794
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: