Individual
COREY N FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1 GUTHRIE ANX, UW BOX 351635, SEATTLE, WA 98195-0001
(206) 543-6511
(206) 616-8367
Mailing address
1 GUTHRIE ANX, UW BOX 351635, SEATTLE, WA 98195-0001
(206) 543-6511
(206) 616-8367
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY00001365
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U09438
REGENCEBLUESHIELD
WA
Enumeration date
03/21/2007
Last updated
07/08/2007
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