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General NPI Number Information
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NPI Number | 1689223893
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Entity Type | Individual
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Provider Name | KELLY MARIE ALLRED PHD
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 1660 S COLUMBIAN WAY
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City | SEATTLE
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State | WA
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Zip | 98108-1532
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Country | US
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Telephone | 206-764-2945
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W OLYMPIC PL APT 711
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City | SEATTLE
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State | WA
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Zip | 98119-3662
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Country | US
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Telephone | 717-919-8073
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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 | PY60922922
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License Number State | WA
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