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NPI Code Detail

MEDICARE: KAYLEIGH CORPUZ O'DONNELL PHD

MEDICARE: KAYLEIGH CORPUZ O'DONNELL 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
1103TS0200XSchool Psychologist
2103TH0100XHealth Service Psychologist

General Provider Information

NPI Number : 1689349151
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLEIGH CORPUZ O'DONNELL PHD
Provider Business Mailing Address
First Line : 4126 E MADISON ST STE 204
Second Line :
City : SEATTLE
State : WA
Zip : 98112-3345
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4126 E MADISON ST STE 204
Second Line :
City : SEATTLE
State : WA
Zip : 98112-3345
Country : US
Telephone Number : 206-926-9901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 04/01/2022

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