Provider Demographics
NPI:1114031176
Name:RECKNAGEL, GEORGE WILLIAM JR (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:RECKNAGEL
Suffix:JR
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 1:4819 NE 93RD ST
Mailing Address - Street 2:P.O. BOX 15153
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3930
Mailing Address - Country:US
Mailing Address - Phone:206-818-4179
Mailing Address - Fax:
Practice Address - Street 1:9 LAKE BELLEVUE DR STE 217
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2454
Practice Address - Country:US
Practice Address - Phone:206-818-4179
Practice Address - Fax:206-729-1479
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical