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General NPI Number Information
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NPI Number | 1841221207
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Entity Type | Individual
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Provider Name | KELLY A DICKINSON PH. D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 522 W RIVERSIDE AVE # 6728
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City | SPOKANE
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State | WA
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Zip | 99201-0580
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Country | US
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Telephone | 253-553-3483
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Fax |
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Provider Business Mailing Address
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Address Line | 32020 32ND AVE S STE 110
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City | FEDERAL WAY
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State | WA
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Zip | 98001-9349
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Country | US
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Telephone | 253-838-3090
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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 | PY3728
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License Number State | WA
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