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General NPI Number Information
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NPI Number | 1275070799
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Entity Type | Individual
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Provider Name | BONNY CHANG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2017
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 3250 AIRPORT WAY S STE 530
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City | SEATTLE
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State | WA
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Zip | 98134-2111
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Country | US
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Telephone | 732-703-6880
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 SW TRENTON ST # 1108
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City | SEATTLE
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State | WA
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Zip | 98106-3206
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Country | US
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Telephone | 732-703-6880
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 60704331
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License Number State | WA
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