Organization
IREDALE PROFESSIONAL SERVICES
Active
Organization
IREDALE PROFESSIONAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRUDY A IREDALE PHD (OWNER/PSYCHOLOGIST)
(360) 991-0134
Entity
Organization
Contact information
Practice address
1804 SE 170TH AVE, VANCOUVER, WA 98683-3474
(360) 991-0134
(360) 991-0154
Mailing address
1804 SE 170TH AVE, VANCOUVER, WA 98683-3474
(360) 991-0134
(360) 991-0154
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770649402
NPI
—
01
—
1841811783
TYPE II NPI
—
01
—
PY00003097
WA STATE LICENSE
WA
Enumeration date
05/01/2020
Last updated
08/19/2020
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