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NPI Code Detail

MEDICARE: DR. PATRICK BEAU REILLY PH.D.

MEDICARE: DR. PATRICK BEAU REILLY PH.D.
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 PsychologistPY60219659WA

General Provider Information

NPI Number : 1427249895
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK BEAU REILLY PH.D.
Provider Business Mailing Address
First Line : 1871 NW GILMAN BLVD
Second Line :
City : ISSAQUAH
State : WA
Zip : 98027-8116
Country : US
Telephone Number : 425-657-0620
Fax Number : 425-677-7415
Provider Business Practice Location Address
First Line : 1871 NW GILMAN BLVD
Second Line :
City : ISSAQUAH
State : WA
Zip : 98027-8116
Country : US
Telephone Number : 425-657-0620
Fax Number : 425-677-7415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2007
Last Update Date : 09/19/2011

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