Provider Demographics
NPI:1437384419
Name:ENGSTROM, MARK DENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DENNIS
Last Name:ENGSTROM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 44TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1908
Mailing Address - Country:US
Mailing Address - Phone:773-227-7723
Mailing Address - Fax:206-685-3244
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356490
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-6216
Practice Address - Fax:206-685-3244
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist