Provider Demographics
NPI:1871604769
Name:SCOVILL, REA ANNE (PHD)
Entity type:Individual
Prefix:
First Name:REA
Middle Name:ANNE
Last Name:SCOVILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11126 SE 256-0-201
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030
Mailing Address - Country:US
Mailing Address - Phone:253-859-2313
Mailing Address - Fax:425-430-1109
Practice Address - Street 1:11126 SE 256-0-201
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030
Practice Address - Country:US
Practice Address - Phone:253-859-2313
Practice Address - Fax:425-430-1109
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1032103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist