Provider Demographics
NPI:1891040200
Name:VINEY, ELIZABETH ANN KOENIG (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN KOENIG
Last Name:VINEY
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 1:8226 BRACKEN PL SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-2935
Mailing Address - Country:US
Mailing Address - Phone:425-428-9759
Mailing Address - Fax:425-278-6071
Practice Address - Street 1:8226 BRACKEN PL SE STE 200
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-2935
Practice Address - Country:US
Practice Address - Phone:425-428-9759
Practice Address - Fax:425-278-6071
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60386629103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid