Provider Demographics
NPI:1225187297
Name:BECKER, VIRGINIA GRAFTON (PSYD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:GRAFTON
Last Name:BECKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N 182ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4402
Mailing Address - Country:US
Mailing Address - Phone:206-542-6670
Mailing Address - Fax:206-542-5235
Practice Address - Street 1:727 N 182ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4402
Practice Address - Country:US
Practice Address - Phone:206-542-6670
Practice Address - Fax:206-542-5235
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGR2317OtherREGENCE PIN
5374575OtherAETNA US HEALTHCARE