Provider Demographics
NPI:1790827343
Name:KETCHAM, BARBARA D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:D
Last Name:KETCHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2904 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-737-8150
Mailing Address - Fax:360-567-0709
Practice Address - Street 1:2904 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-737-8150
Practice Address - Fax:360-567-0709
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWAPY2041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist