# WESTERN WASHINGTON MEDICAL GROUP, INC PS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WESTERN WASHINGTON MEDICAL GROUP
- **Other names:** Western Wa Medical Group Dept of Psychology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1326266727
- **Legal business name:** WESTERN WASHINGTON MEDICAL GROUP
- **Authorized official:** MS. VICKI MCGINNIS (PRIVACY OFFICER)
- **Authorized official phone:** (425) 259-4041

## Contact information

- **Practice address:** 3525 COLBY AVE STE 200, EVERETT, WA 98201-4782
- **Practice address phone:** (425) 259-1366
- **Practice address fax:** (425) 252-4778
- **Mailing address:** 3525 COLBY AVE STE 200, EVERETT, WA 98201-4782
- **Mailing address phone:** (425) 259-1366
- **Mailing address fax:** (425) 252-4778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 601474013 | WA | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 08/25/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0202207 | LABOR & INDUSTRY | WA |