Doctor Name: | MRS. REBECCA L DUDLEY |
NPI Number: | 1235563859 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED |
License Number: | CG 60400466 |
Business Practice Address: | 4127 93rd Ave Se Mercer Island, WA - 980404218 |
Business Phone Number: | 2062269557 |
Business Fax Number: | |
Mailing Address: | 4127 93rd Ave Se, MERCER ISLAND |
State: | WA |
Postal Code: | 980404218 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/30/2013 |
NPI Last Update Date: | 08/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | CG 60400466 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |