MEDICARE: SEATTLE PSYCHOLOGISTS, PS

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

General Provider Information

NPI Number	:	1326189507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEATTLE PSYCHOLOGISTS, PS

Provider Business Mailing Address
First Line	:	5413 MERIDIAN AVE N
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98103-6168
Country	:	US
Telephone Number	:	206-545-7500
Fax Number	:	206-632-4767

Provider Business Practice Location Address
First Line	:	5413 MERIDIAN AVE N
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98103-6168
Country	:	US
Telephone Number	:	206-545-7500
Fax Number	:	206-632-4767

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAROLYN NORA ROLL
Credential	:	PHD
Telephone Number	:	206-545-7500

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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