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Organization

LEAPSS AND BEYOND

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EDWYN W ORTIZ-NANCE PSYD (CLINICALAND NEUROPSYCHOLOGIST)
(559) 824-8934
Entity
Organization

Contact information

Practice address
413 LINCOLN AVE STE A, MUKILTEO, WA 98275-1524
(559) 314-4696
Mailing address
413 LINCOLN AVE STE A, MUKILTEO, WA 98275-1524
(559) 314-4696

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PY60221926
WA
103T00000X
Psychologist
Primary
PS60221926
WA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PY60221926
WA
103TP2701X
Group Psychotherapy Psychologist
PY60221926
WA

Other

Enumeration date
08/11/2011
Last updated
08/11/2011
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