Provider Demographics
NPI:1588002646
Name:CHIDESTER, JAMES A II (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:CHIDESTER
Suffix:II
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 1:1720 130TH AVE NE STE 149
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2272
Mailing Address - Country:US
Mailing Address - Phone:425-429-1537
Mailing Address - Fax:
Practice Address - Street 1:1720 130TH AVE NE STE 149
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2272
Practice Address - Country:US
Practice Address - Phone:425-429-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60361570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical