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NPI Code Detail

MEDICARE: VANESSA G DZIVAKWE PHD

MEDICARE: VANESSA G DZIVAKWE PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY 60666097WA

General Provider Information

NPI Number : 1013340793
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA G DZIVAKWE PHD
Provider Business Mailing Address
First Line : 509 OLIVE WAY STE 204
Second Line :
City : SEATTLE
State : WA
Zip : 98101-1726
Country : US
Telephone Number : 206-329-5255
Fax Number : 206-726-1878
Provider Business Practice Location Address
First Line : 509 OLIVE WAY STE 204
Second Line :
City : SEATTLE
State : WA
Zip : 98101-1726
Country : US
Telephone Number : 206-329-5255
Fax Number : 206-726-1878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2013
Last Update Date : 07/21/2022

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Directions to “ VANESSA G DZIVAKWE PHD” Practice Location

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