Provider Demographics
NPI:1689726366
Name:VANCE, ELLEN BELLE (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:BELLE
Last Name:VANCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N NORTHLAKE WAY
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9051
Mailing Address - Country:US
Mailing Address - Phone:206-525-1382
Mailing Address - Fax:206-525-1382
Practice Address - Street 1:1900 N NORTHLAKE WAY
Practice Address - Street 2:SUITE 127
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9051
Practice Address - Country:US
Practice Address - Phone:206-525-1382
Practice Address - Fax:206-525-1382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA626103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27413Medicare ID - Type Unspecified