MEDICARE: DR. MARY JOSEPHINE HENDRICKSON 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
1	103T00000X	Psychologist	PY00002719	WA

General Provider Information

NPI Number	:	1699755561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JOSEPHINE HENDRICKSON PHD

Provider Business Mailing Address
First Line	:	22500 SE 64TH PL STE 230
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8111
Country	:	US
Telephone Number	:	425-409-6414
Fax Number	:	425-409-6618

Provider Business Practice Location Address
First Line	:	22500 SE 64TH PL STE 230
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8111
Country	:	US
Telephone Number	:	425-409-6414
Fax Number	:	425-409-6618

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/03/2025

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