MEDICARE: DR. ANDREW RYAN DEVENDORF 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	PSYC.PY.61670611	WA

General Provider Information

NPI Number	:	1841133295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW RYAN DEVENDORF PHD

Provider Business Mailing Address
First Line	:	4801 RAINIER AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2181
Country	:	US
Telephone Number	:	847-946-2786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 RAINIER AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2181
Country	:	US
Telephone Number	:	847-946-2786
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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