Provider Demographics
NPI:1356531735
Name:HOSSACK, ROBERT CLEMENT (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLEMENT
Last Name:HOSSACK
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 1:40 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2479
Mailing Address - Country:US
Mailing Address - Phone:425-643-0548
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2479
Practice Address - Country:US
Practice Address - Phone:425-643-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002975103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical