Individual
DR. KRISTINE RAE VANDERMARK POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1800 COOPER POINT RD SW, BLDG 17, OLYMPIA, WA 98502-1178
(360) 352-4602
Mailing address
7825 CANTERWOOD DR SE, OLYMPIA, WA 98513-6520
(360) 459-3447
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY00002568
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0157189
L AND I
WA
01
—
PY00002568
STATE LICENSE
WA
Enumeration date
01/05/2007
Last updated
07/08/2007
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