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General NPI Number Information
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NPI Number | 1427388628
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Entity Type | Individual
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Provider Name | DANIELLE NICOLE DOLEZAL PH.D., BCBA-D
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Gender | Female
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 4800 SAND POINT WAY NE W-3621
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City | SEATTLE
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State | WA
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Zip | 98105-3901
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Country | US
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Telephone | 206-987-2051
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Fax | 206-987-2246
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Provider Business Mailing Address
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Address Line | 4800 SAND POINT WAY NE W-3621
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City | SEATTLE
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State | WA
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Zip | 98105-3901
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Country | US
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Telephone | 206-987-2051
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Fax | 206-987-2246
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSYC.PY.60116201
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License Number State | WA
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