MEDICARE: TERESA SWEENEY 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
1	103T00000X	Psychologist	1090	WA

General Provider Information

NPI Number	:	1649258518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA SWEENEY PH.D.

Provider Business Mailing Address
First Line	:	200 W MERCER ST
Second Line	:	#200
City	:	SEATTLE
State	:	WA
Zip	:	98119-3958
Country	:	US
Telephone Number	:	206-282-3282
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W MERCER ST
Second Line	:	#200
City	:	SEATTLE
State	:	WA
Zip	:	98119-3995
Country	:	US
Telephone Number	:	206-282-3282
Fax Number	:

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

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	07/08/2007

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