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General NPI Number Information
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NPI Number | 1376757575
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Entity Type | Organization
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Legal Business Name | GARY VANDALFSEN, PHD, P.S.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11808 NORTHUP WAY SUITE W-150
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City | BELLEVUE
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State | WA
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Zip | 98005-1936
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Country | US
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Telephone | 425-822-0242
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Fax |
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Provider Business Mailing Address
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Address Line | 11808 NORTHUP WAY SUITE W-150
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City | BELLEVUE
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State | WA
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Zip | 98005-1936
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Country | US
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Telephone | 425-822-0242
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY ALLEN VANDALFSEN
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Credential | PH.D.
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Telephone | 425-822-0242
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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 | PY00001869
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License Number State | WA
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