Provider Demographics
NPI:1851330716
Name:KEHRER, CONSTANCE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:A
Last Name:KEHRER
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 1:1601 114TH AVE SE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6950
Mailing Address - Country:US
Mailing Address - Phone:425-454-3110
Mailing Address - Fax:425-283-0486
Practice Address - Street 1:1601 114TH AVE SE
Practice Address - Street 2:SUITE 145
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6950
Practice Address - Country:US
Practice Address - Phone:425-454-3110
Practice Address - Fax:425-283-0486
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPY00002551OtherPROFESSIONAL LICENSE
WA0203722OtherLABOR AND INDUSTRIES ID
WA8858254Medicare ID - Type Unspecified
WAPY00002551OtherPROFESSIONAL LICENSE