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General NPI Number Information
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NPI Number | 1831385624
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Entity Type | Individual
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Provider Name | WANDEE JOHNSON PRYOR PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 20174 FRONT ST NE
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City | POULSBO
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State | WA
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Zip | 98370-7445
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Country | US
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Telephone | 360-697-1141
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1611 THE FRONT STREET CLINIC
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City | POULSBO
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State | WA
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Zip | 98370-7445
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Country | US
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Telephone | 360-697-1141
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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 | 24125
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 60412791
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License Number State | WA
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