Provider Demographics
NPI:1053511360
Name:JOSEPH S. VIZZARD, PH.D., P.S,
Entity Type:Organization
Organization Name:JOSEPH S. VIZZARD, PH.D., P.S,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:.PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:VIZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-771-8011
Mailing Address - Street 1:8311 212TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7443
Mailing Address - Country:US
Mailing Address - Phone:425-771-8011
Mailing Address - Fax:425-771-8009
Practice Address - Street 1:8311 212TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7443
Practice Address - Country:US
Practice Address - Phone:425-771-8011
Practice Address - Fax:425-771-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY0001307103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVI9735OtherREGENCE INSURANCE
WA7115884Medicaid
WA37852OtherDEPARTMENT OF LABOR & INDUSTRIES
WAVI9735OtherREGENCE INSURANCE