Provider Demographics
NPI:1376692491
Name:COFFMAN, SANDRA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 WESTERN AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2003 WESTERN AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2161
Practice Address - Country:US
Practice Address - Phone:206-441-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA871103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist