Provider Demographics
NPI:1902019201
Name:BALDERSON, BENJAMIN HK (PHD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HK
Last Name:BALDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 MINOR AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1466
Mailing Address - Country:US
Mailing Address - Phone:206-287-2500
Mailing Address - Fax:
Practice Address - Street 1:1730 MINOR AVE STE 1400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1466
Practice Address - Country:US
Practice Address - Phone:206-287-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8879999Medicare PIN
WAG8879998Medicare PIN