Provider Demographics
NPI:1568560282
Name:SMETKO, PAUL DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:SMETKO
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 1:10604 NE 38TH PL
Mailing Address - Street 2:SUITE 132
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7933
Mailing Address - Country:US
Mailing Address - Phone:425-739-0101
Mailing Address - Fax:
Practice Address - Street 1:10604 NE 38TH PL
Practice Address - Street 2:SUITE 132
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7933
Practice Address - Country:US
Practice Address - Phone:425-739-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical