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NPI Code Detail

MEDICARE: DR. CRYSTAL M DELOACH PHD

MEDICARE: DR. CRYSTAL M DELOACH 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
1103TC0700XClinical Psychologist2591WA

General Provider Information

NPI Number : 1356407639
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRYSTAL M DELOACH PHD
Provider Business Mailing Address
First Line : 210 W GALER ST
Second Line :
City : SEATTLE
State : WA
Zip : 98119-3332
Country : US
Telephone Number : 206-448-6944
Fax Number : 206-448-6945
Provider Business Practice Location Address
First Line : 210 W GALER ST
Second Line :
City : SEATTLE
State : WA
Zip : 98119-3332
Country : US
Telephone Number : 206-448-6944
Fax Number : 206-448-6945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 06/03/2026

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