Provider Demographics
NPI:1447363007
Name:WOLCOTT, LINDA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:193607 E 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5581
Mailing Address - Country:US
Mailing Address - Phone:509-551-6799
Mailing Address - Fax:509-579-0156
Practice Address - Street 1:100 N MORAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2905
Practice Address - Country:US
Practice Address - Phone:509-551-6799
Practice Address - Fax:509-491-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60839458103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890013330Medicaid