Provider Demographics
NPI:1255601399
Name:KWONG, AGNES (PHD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:KWONG
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 1:338 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3120
Mailing Address - Country:US
Mailing Address - Phone:206-434-1522
Mailing Address - Fax:206-494-4562
Practice Address - Street 1:338 NW 85TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3120
Practice Address - Country:US
Practice Address - Phone:206-659-5945
Practice Address - Fax:206-494-4562
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60126753103T00000X
WAPY60126753103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1255601399OtherNPI