Provider Demographics
NPI:1649495201
Name:WALL, VALERIE JANE (PHD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:JANE
Last Name:WALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:J
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1320 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2837
Mailing Address - Country:US
Mailing Address - Phone:206-325-5700
Mailing Address - Fax:206-328-5005
Practice Address - Street 1:1320 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2837
Practice Address - Country:US
Practice Address - Phone:206-325-5700
Practice Address - Fax:206-328-5005
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist