Provider Demographics
NPI:1174662381
Name:LOWE, MONIQUE RENEE (PHD, LP)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:RENEE
Last Name:LOWE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 114TH AVE SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6942
Mailing Address - Country:US
Mailing Address - Phone:425-454-2835
Mailing Address - Fax:425-454-2315
Practice Address - Street 1:1300 114TH AVE SE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6942
Practice Address - Country:US
Practice Address - Phone:425-454-2835
Practice Address - Fax:425-454-2315
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60226299103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist