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Individual

KENYACKTIE HARTSHORN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
16251 SYLVESTER RD SW, BURIEN, WA 98166-3017
(253) 226-1369
Mailing address
PO BOX 25173, FEDERAL WAY, WA 98093-2173

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY60212285
WA
103TA0700X
Adult Development & Aging Psychologist
PY60212285
WA
103TC0700X
Clinical Psychologist
Primary
PY60212285
WA

Other

Enumeration date
04/13/2011
Last updated
12/03/2016
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