Provider Demographics
NPI:1417939992
Name:VALEITHIAN, CHERIE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:M
Last Name:VALEITHIAN
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 1:20701 104TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1561
Mailing Address - Country:US
Mailing Address - Phone:253-813-0481
Mailing Address - Fax:253-867-1606
Practice Address - Street 1:20701 104TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1561
Practice Address - Country:US
Practice Address - Phone:253-813-0481
Practice Address - Fax:253-867-1606
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002490103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB39384Medicare PIN