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General NPI Number Information
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NPI Number | 1255680468
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Entity Type | Individual
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Provider Name | MS. STACIE RAE KEIRSEY
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Gender | Female
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 14655 NE BEL RED RD STE 203
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City | BELLEVUE
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State | WA
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Zip | 98007-3900
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Country | US
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Telephone | 425-243-5407
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Fax |
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Provider Business Mailing Address
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Address Line | 1829 140TH AVE SE
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City | BELLEVUE
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State | WA
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Zip | 98005-4040
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60789950
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License Number State | WA
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