Provider Demographics
NPI:1013340793
Name:DZIVAKWE, VANESSA G (PHD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:G
Last Name:DZIVAKWE
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 1:509 OLIVE WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1726
Mailing Address - Country:US
Mailing Address - Phone:206-329-5255
Mailing Address - Fax:206-726-1878
Practice Address - Street 1:509 OLIVE WAY STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1726
Practice Address - Country:US
Practice Address - Phone:206-329-5255
Practice Address - Fax:206-726-1878
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60666097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist