Provider Demographics
NPI:1558534982
Name:GROESSCHELL, MARTHA HARING (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:HARING
Last Name:GROESSCHELL
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 1:420 5TH AVE S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3464
Mailing Address - Country:US
Mailing Address - Phone:206-353-3638
Mailing Address - Fax:425-778-3638
Practice Address - Street 1:420 5TH AVE S
Practice Address - Street 2:SUITE 103
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3464
Practice Address - Country:US
Practice Address - Phone:206-353-3638
Practice Address - Fax:425-778-3638
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003889103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent