Provider Demographics
NPI:1922506377
Name:DEWITT, DIANE WEYER (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:WEYER
Last Name:DEWITT
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 1:12356 NORTHUP WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1956
Mailing Address - Country:US
Mailing Address - Phone:425-867-1500
Mailing Address - Fax:
Practice Address - Street 1:12356 NORTHUP WAY STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1956
Practice Address - Country:US
Practice Address - Phone:425-867-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0893103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic