Provider Demographics
NPI:1033252051
Name:DUNCAN, SAMUEL WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WAYNE
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NE 125TH ST.
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4357
Mailing Address - Country:US
Mailing Address - Phone:296-361-6884
Mailing Address - Fax:206-361-1598
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 225
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:296-361-6884
Practice Address - Fax:206-361-1598
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0005565417OtherAETNA
WADU5108OtherREGENCE BLUE SHIELD
WA91139348514OtherUNIFORM MEDICAL PLAN