=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104061944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN WEISBARD, PSYD, P.S. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2008
-----------------------------------------------------
Last Update Date | 01/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5122 25TH AVE NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-525-6783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5122 25TH AVE NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-525-6783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KAREN HOPE WEISBARD
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 206-525-6783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 01578
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------