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General NPI Number Information
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NPI Number | 1912588088
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGY AND REHABILITATION SERVICES OF WASHINGTON
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 1455 NW LEARY WAY STE 400A
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City | SEATTLE
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State | WA
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Zip | 98107-5138
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Country | US
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Telephone | 425-209-0828
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 242ND PL SW
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City | BOTHELL
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State | WA
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Zip | 98021-9349
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Country | US
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Telephone | 425-209-0828
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Fax |
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Authorized Official
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Title or Position | OWNER/NEUROPSYCHOLOGIST
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Name | KELLY AKIKO CORNETT
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Credential | PSYD
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Telephone | 425-209-0828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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