MEDICARE: VIRGINIA GRAFTON BECKER PSYD

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
1	103TC0700X	Clinical Psychologist	PY00001311	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GR2317	OTHER	WA	REGENCE PIN
2	5374575	OTHER		AETNA US HEALTHCARE

General Provider Information

NPI Number	:	1225187297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA GRAFTON BECKER PSYD

Provider Business Mailing Address
First Line	:	727 N 182ND ST
Second Line	:	SUITE 202
City	:	SHORELINE
State	:	WA
Zip	:	98133-4402
Country	:	US
Telephone Number	:	206-542-6670
Fax Number	:	206-542-5235

Provider Business Practice Location Address
First Line	:	727 N 182ND ST
Second Line	:	SUITE 202
City	:	SHORELINE
State	:	WA
Zip	:	98133-4402
Country	:	US
Telephone Number	:	206-542-6670
Fax Number	:	206-542-5235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/09/2007

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Directions to “ VIRGINIA GRAFTON BECKER PSYD” Practice Location

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