Provider Demographics
NPI:1790757292
Name:DE VRIES, RONALD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:DE VRIES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16040 CHRISTENSEN RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2934
Mailing Address - Country:US
Mailing Address - Phone:206-431-5336
Mailing Address - Fax:206-431-5430
Practice Address - Street 1:16040 CHRISTENSEN RD
Practice Address - Street 2:SUITE 212
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2934
Practice Address - Country:US
Practice Address - Phone:206-431-5336
Practice Address - Fax:206-431-5430
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY1995103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical