Provider Demographics
NPI:1154464253
Name:GLAWE, VIRGINIA HARSTAD (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:HARSTAD
Last Name:GLAWE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GINGER
Other - Middle Name:HARSTAD
Other - Last Name:GLAWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:7018 31ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5905
Mailing Address - Country:US
Mailing Address - Phone:206-985-8951
Mailing Address - Fax:
Practice Address - Street 1:7018 31ST AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5905
Practice Address - Country:US
Practice Address - Phone:206-985-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS11351Medicare UPIN