Provider Demographics
NPI:1164506242
Name:THOMAS W & VALERIE J WALL PHD PS
Entity Type:Organization
Organization Name:THOMAS W & VALERIE J WALL PHD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-325-5700
Mailing Address - Street 1:1320 UNIVERSITY STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-325-5700
Mailing Address - Fax:206-328-5005
Practice Address - Street 1:1320 UNIVERSITY STREET
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-325-5700
Practice Address - Fax:206-328-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA PSY 1236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty