Provider Demographics
NPI:1518040732
Name:LEE, SCOTT WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAM
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 NE 112TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4111
Mailing Address - Country:US
Mailing Address - Phone:425-821-3966
Mailing Address - Fax:425-821-3966
Practice Address - Street 1:12412 NE 112TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4111
Practice Address - Country:US
Practice Address - Phone:425-821-3966
Practice Address - Fax:425-821-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000106293Medicare ID - Type Unspecified
WA000106293Medicare PIN